Cost Warrior

When senior vice president Bob Worthington talks about "Idea Avenue," he's not referring to BlueCross BlueShield of Tennessee's Chattanooga headquarters, but to a culture that encourages employees to incubate ideas at the metaphorical watercooler. By putting those ideas into practice, BCBST ($1.9 billion in 2003 revenue) has become somewhat of an early adopter of technology. Worthington is especially willing to put his neck out on initiatives that "attack healthcare costs," such as electronic health records.

I&T: How can insurers such as BCBST lower the cost of healthcare?

Worthington: Today in the healthcare industry we're seeing employers reduce healthcare plan benefits while increasing the share their employees pay as a way to manage costs. But this just shifts costs from one player to another - it doesn't address the fundamental issue of the cost of healthcare itself. By transforming healthcare technology at the point where care is delivered - at the physician's or at the test provider's office - we as insurers can lower the healthcare cost structure.

I&T: Do you have any initiatives under way that will attack costs on the provider side?

Worthington: We're starting down that path with a project named SharedHealth. We are piloting the program in four locations in Tennessee and plan a significant rollout in April. SharedHealth will make patient health records available electronically to physicians in hospital emergency rooms. Patients admitted to the ER typically are in a state of anxiety and stress and may not tell, or be able to tell, the ER physician their health history or what drugs they are on. This can adversely affect how care is ordered and undertaken.

Embedded within SharedHealth is information from both the provider and the payer, such as formulary rules, generic drug options and the financial impact on the member as to the choice being made. SharedHealth will reduce waste and duplication in the healthcare delivery process by decreasing needless tests and the tremendous cost of over-care. That's why we say this is a way to get at the fundamental cost structure.

I&T: With what entities do you need to interface to deliver the data contained in SharedHealth?

Worthington: We need to be tightly integrated with hospitals' information systems and are working with a partner we can't yet disclose to help us with the integration. We also need to interface with the physician practice management systems. It's a big integration challenge, and we decided early on that we needed relationships with the provider community. We also need to make sure that the relationship is seen as collaborative rather than antagonistic.

I&T: Does this integration require any retrofitting of your internal systems?

Worthington: Not at all. We extracted data from our systems, and our strategic partner reformatted it to plug right into their electronic medical record interface.

I&T: Other than cost reductions, how will this type of initiative benefit your organization?

Worthington: The electronic health record really is a community gesture that helps doctors learn more about patients so they can deliver better healthcare. But we found that when we brought together data from the provider and the payer, the system was actually able to detect persons using multiple identifications to abuse the system. We had no intention for this to be an outcome, but it looks like there is tremendous potential for detecting fraud. We've demonstrated this capability to the Tennessee governor as an innovative way to bring the cost of healthcare under control.

I&T: How would you describe BCBST's technology philosophy? Are you early adopters or do you tend to take a wait-and-see approach?

Worthington: Within the last four or five years we have put together technology capabilities that could be considered leading edge. We're not entirely comfortable being out in front, but that's the position we are in. For example, we were doing e-business in 1998 long before a lot of the other payers. We talked to a lot of vendors about capabilities and often entered these discussions as an early adopter. We would get into a win-win situation with vendors where we help them sell more products in return for getting a lower-cost product customized to our needs. BCBST doesn't live up to the typical image of the insurance industry dinosaur; there is a different spirit going on inside our company.

I&T: What emerging technologies will impact the insurance industry in the next few years?

Worthington: Wireless will have a significant impact on insurance. It makes everything mobile; you don't have to think of yourself as restricted to a time and place. We've been doing some front-end experimentation with wireless PDAs and, as luck would have it, our CEO is one of our guinea pigs. She travels a lot, and through wireless technology she can continue to get her e-mails and interact even when she is on the road. I see the company of the future living in wireless - the days of staying within the four walls of the corporation are long gone.