Q&A: Blue Cross Blue Shield MA – how IoT is changing health...
Q&A: Blue Cross Blue Shield MA - how IoT is changing health insurance

    Q&A: Blue Cross Blue Shield MA – how IoT is changing health insurance

    Internet of Business spends five minutes with Bruce Nash, chief physician officer, Blue Cross Blue Shield Massachusetts, talking IoT and its impact on the future of health insurance.

    What would you consider the Top Three ways in which digital health and IoT are impacting health insurance companies?

    I think it is all about the predictive modeling and identifying the individuals that are currently off the radar but that do represent higher health risks. That is going to help us intervene earlier than we used to and provide them with better support and care navigation, helping the provider deliver better care to them.

    Bruce Nash, chief physician officer, Blue Cross Blue Shield Massachusetts

    What do you think the health insurance and health plan user relationship will look like in the future? How is that going to evolve throughout the next five-to-ten years?

    From the patient perspective, I think the bright line distinctions between the payer and the provider will soften quite a bit, because the patient will be provided with the information they need in a much easier manner. They will not have to call the payer to understand their benefits but it will simply be adjudicated at the point of care. Patients will be able to know going into an elective procedure what it is that provider is going to do and be given exactly what the financial exposure is going to be driven by the specific contracts that provider has with their health plan. We are going to see a lot more efficient communication between the payer and the provider. Requirements that currently create a lot of administrative inefficiency, such as prior authorization, will be replaced by natural language extracts of medical records being compared to optimal care guidelines.

    How is Blue Cross Blue Shield Massachusetts being transformed by data analytics? Do you see key changes taking place already?

    Historically, health plans have had claims data as their prime data source. Increasingly, we are receiving data from other sources. There is obviously the rich amount of data that is present in the Electronic Health Records. We are currently receiving some of that data, as well as biometrics data from work- site health screening. We incorporate these data into sophisticated models for predictive modeling which identify those members that we should outreach to and assist further. “Big data” has the potential to advance this identification effort further and guide our outreach in a manner that best meets the individual patient’s preferences.

    An increasing number of health providers are saying they would like to improve communication and collaboration with the health insurance companies they are working with. One of their key preoccupations is reimbursement and ensuring technology buy-in from health insurance companies. In your opinion, what sort of milestones do you need to see in these innovative technologies to reimburse some of these new digital health technologies?

    As the ultimate steward of the patient’s dollar, basically anything we pay for passes through to their premium. Any health plan would be happy to extend coverage to a new technology if they were convinced that it is providing the same or better care at a lower cost. Obviously the concern is always: ‘Are we just talking about additive cost?’ Maybe that particular technology works out in a small trial but it is not going to work when you scale it up to a larger patient population. We will never have perfect data, but we will always seek to have the most robust data over a sufficient period of time and over a sufficiently large patient cohort so that we have statistically significant and clinically meaningful outcomes t before we are willing to extend coverage.

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    Is there a specific digital health technology that who think holds the most potential for improving clinical outcomes and patient experience whilst reducing the cost of healthcare?

    I think there is a big opportunity for technology to reduce the administrative cost of healthcare, which will improve the relationship between payers and providers. However, administrative costs represent a small portion of the health care dollar.. The real opportunity, in the near term, exists in the treatment of chronic disease. Although there is some progress in this area, I am not aware of anything transformative as of yet.

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    Bruce Nash is the Chief Physician Executive for Blue Cross Blue Shield of Massachusetts, leading the Health and Medical Management Division at Blue Cross, which is responsible for care and utilization management activities for medical and behavioral health.

    He has over 25 years of health care management and clinical experience in medical group practice, hospital, and managed care settings. Bruce will be speaking at Internet of Health in Boston from October 31 – November 1. For further details, click here or join us on Twitter using the hashtag #IoT4health.