In a health care environment built on technology, with treatments and decisions necessitated by patient history and health details, it’s no longer adequate to depend on paper files. The benefits of health information technology require a data access and connectivity that literally shares those personalized details when needed to speed and confirm the accurate medical response. With clinical health records, integrated health management and health care advocates, BlueCross BlueShield of Tennessee is creating technology and individualized care solutions that improve and personalize care.

Shared Health, a subsidiary of BlueCross BlueShield of Tennessee, is the nation’s largest public/private health information exchange, with Web-based applications that securely share and connect medical information across a patient’s network of clinicians. The Clinical Health Record is a secure, electronic health record that stores and maintains a comprehensive view of a patient’s specific medical history, allowing multiple clinicians treating the same patient to view that patient’s clinical history, including prescription compliance. With ePrescribe technology, clinicians can even prescribe medications via a secure Web portal, enabling more informed clinical decisions at the point of care.

The Clinical Health Record and related technology work together to ensure that a participating patient – whether visiting a primary care provider, specialist or emergency department – has information securely available to speed the assessment, diagnosis, and treatment process.

In 2007, the results of a research study showed a 17 percent improvement in efficiencies following implementation of the Shared Health information exchange within a clinician’s practice workflow. The physician-centered solution enables active care management with significant value – all of which results in a more efficient and effective health care system where we deliver on the promise of health information technology.

Furthering the delivery of personalized care, BlueCross BlueShield of Tennessee is using a total health management approach to integrate wellness programs, care coordination support and case management in a way that provides member touchpoints and care intervention opportunities at points along the entire continuum of care. Proactive identification of potential at-risk members is critical to maintaining effective, efficient and appropriate interventions across the spectrum of care. Using online personal health assessments and predictive modeling, members are identified and stratified according to individual risk level and potential participation across all available programs – from lifestyle coaching for low-risk members, to chronic or complex disease management for others, based on their particular health situation and need.

In addition, personalized care advocacy leverages the integrated technology in a way that allows nurses and care advocates to see the entire spectrum of care that a member receives, plus the opportunity to participate and benefit from any additional programs, resources and support that may be available and appropriate for their specific needs. In short, coordinating and expanding care through every touchpoint to further enhance the quality and effectiveness of each person’s care decisions and treatment plans.

As clinical support and to combat the serious threat of pulmonary embolism, BlueCross BlueShield of Tennessee stepped up in 2007 as the first managed care organization in the country to launch a quality deep-vein thrombosis awareness and prevention program. As many as 200,000 DVT-related pulmonary embolism deaths occur each year – more than from breast cancer and AIDS combined. Having the data and resources to proactively reach out to plan members with education and monitoring led to a pilot program to help produce healthier outcomes for more than 440 initial participants, which resulted in an estimated $1.2 million cost savings for members and their plan. To date, more than 1,500 members have benefited from the program.

Volunteer State Health Plan, a subsidiary of BlueCross BlueShield of Tennessee, achieved record health screening rates in 2007 for its TennCare youth population. With a 95 percent rate among BlueCare members and 92 percent for TennCareSelect, the plan set an all-time company high for early and periodic screening, diagnosis and treatment checkups for the state’s TENNderCare children’s preventive health program. The screenings are vital in preventing illnesses and detecting health problems early – keeping kids on track for a healthy future and reducing the risk of developing unnecessary and costly illnesses.

Bringing the benefits of technology to a paper-cluttered world, tens of thousands of plan members made the switch to online Explanation of Benefit statements in 2007, relying on instant e-mail notices to readily access their information in BlueAccess, the secure portion of the BCBST.com Web site.

In 2007, BlueCross BlueShield of Tennessee also passed a dental membership milestone by providing dental coverage for over 550,000 members – a 45 percent increase since 2005. Linking proper dental care with good medical care is a critical component to the overall health of our members, based on recent studies that link poor dental health with serious health problems, including preterm births. Clinical studies indicate that periodontal disease can lead to complications associated with diabetes, low birth-weight babies, cardiovascular disease and organ transplant failures.