Blue Cross Blue Shield Association to pool claims data to analyze patient spending, manage costs

The Blue Cross Blue Shield Association plans to create a huge database of healthcare claims in a move that participating insurers hope will allow them to spot trends in the data that they can use to control costs.

All 36 independent Blue Cross and Blue Shield companies have made a commitment to contribute information on healthcare quality and costs to an Axis database, the association announced September 24.

The breadth of the data makes Axis the healthcare industry's largest aggregated data source and the only one that includes information from every ZIP code in the United States, according to the association. It reflects more than $350 billion in annual claims, 36 million provider records and more than 700,000 patient reviews.

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The reasoning behind the work, which has been years in the making, is that data is the key to affordability, according to Maureen Sullivan, senior vice president of Strategic Services and chief strategy officer.

The new capability is allowing the amount of information available to quadruple, from an estimated 400 procedures to about 1,600, she said.

Axis combines the secure cost data from more than 2.3 billion healthcare procedures annually, from 96 percent of all U.S. hospitals and 92 percent of all doctors.

"The decision they made is data is the key to unlock affordability," Sullivan said, "to give members the information they need for decisions on healthcare and for employers and for providers to understand the care they're delivering and how it compares to other professionals."

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For patients, it's a transparency tool to see the cost of procedures.

For employers, it offers a benchmark for performance and affordable pricing.

For instance, Sullivan said, the cost of knee surgery varies. An employer can recommend a provider that offers both high quality and low cost. If an employee chooses another provider that offers the same quality at a higher cost, the employer could decide to enter into cost-sharing.

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With over 100 million members in Blue Cross Blue Shield companies, Axis helps make sense of care patterns. Someone tapping into the Chicago, Illinois market might want to know the aggregate cost for an X-ray.

"It helps us develop our network, design benefits, it leads to affordable care," Sullivan said.

Blue Cross and Blue Shield Association is the umbrella for all 36 independent Blue Cross and Blue Shield companies including Anthem BCBS, and covers one in three Americans.

Twitter: @SusanMorseHFN