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New Database a Health Care Powerhouse, Blues Boast

By John Reichard, CQ HealthBeat Editor

August 4, 2006 - The Blue Cross Blue Shield Association held a telephone briefing Friday to announce creation of a database of claims filed on behalf of 79 million enrollees—a treasure trove of information that employers working with health plans can use to extract greater value for their health care dollars.

Called "Blue Health Intelligence," the database is more than twice the size of the next largest database in the United States, the association said in a press release.

The unveiling comes in a health care era in which "information" is king—and data is viewed as the key to unlocking efficiency in a system bloated with excess from spending on unnecessary or overpriced services and products, according to many analysts.

Officials with the Blues described various efficiency and product safety breakthroughs made possible by the massive size of the database, which they called the largest of its type in the world.

One example they point to is the field of comparing treatment outcomes for the same medical condition. Health policy analysts have long touted treatment comparison as having great potential for improving U.S. health care efficiency, but getting such a program off the ground has been a struggle.

Analysts will be able to do head-to-head comparisons of prescription drugs to see which work best—the kind of research industry avoids because of marketplace risks of adverse results, and the kind government infrequently subsidizes.

The expanse of the database—which covers patients in every U.S. ZIP Code, according to Dr. David Plocher, senior vice president for health management and informatics at Minnesota Blue Cross-Blue Shield—means the findings of those comparisons will be far more reliable than studies based on a relatively small number of patients.

Eliminating geographic variations in services—another holy grail in the drive for greater efficiency—also may be within closer reach.

Studies by Dartmouth Medical School researcher John Wennberg and other analysts have documented sharp geographic variations in the use of certain types of surgical and other medical procedures for a specific condition—variations that make health care much more expensive in certain parts of the country with no apparent advantage in outcome.

Plocher said in an interview Friday that the database allows researchers to go beyond simply documenting variations and begin developing more detailed information on the treatment outcomes associated with those variations.

Employers working with Blues plans can use that information to design more efficient health plans. If heavy use of a particular type of imaging in a city or state yields no advantage in outcome, for example, employers in those areas could opt for health plan designs requiring higher co-payments for that service. Or, doctors making heavy use of certain procedures with no advantage in treatment outcomes could be placed in networks requiring higher out-of-pocket payments by enrollees picking them, Plocher said.

Plocher cited an example where the database would permit a publishing company in one part of the country to compare its health costs with those of a branch in another part of the country to determine why costs were rising at different rates. The analysis might find differences in the rate of treatment for low back pain or heart problems, for example, and allow the employer to customize the health plan services it chooses accordingly, he said.

The database also will be used to assess the value of medical devices. For example, it could be used to examine how heart patients with costly implanted defibrillators do compared with patients who do not have the device.

"That's the beauty of this database," Plocher said.

Plocher also pointed up the database's ability to quickly pick up safety problems associated with new drugs and devices. Just as researchers were able to identify safety problems associated with the prescription painkiller Vioxx by combing through a large database of health claims, they also will be able to identify hazards using the new database, but with much greater certainty because of its size, Plocher indicated.

The next largest database with drug data is "one-third this size," he said, referring to Ingenix, based in Eden Prairie, Minn., and operated by the insurer UnitedHealth Group.

As an example of the difficulty researchers have determining safety problems with drugs on the market, Plocher noted a recent call from a drug company researcher trying to determine the incidence of a side effect associated with a new vaccine. The process involved getting claims data in non-standard formats from about 30 companies to try to piece together a safety profile. The new database would permit such an analysis from a single workstation, Plocher said.

However, it has not been determined whether drug manufacturers will be permitted access to the information. The database wasn't envisioned as a way to advance the interest of drugmakers, Plocher said, and the Blues have yet to decide whether they will sell data to drug companies. Access would have to "fit with our mission."

To help with the aim of assessing the effectiveness and safety of drugs, the association has contracted with Harvard and Johns Hopkins researchers to advise on study designs. "We have half a dozen [studies] already planned," Plocher said.

But Blues officials emphasized the use of the data in the employer market. Bob Greczyn, chief executive officer of Blue Cross-Blue Shield of North Carolina, said the database is a "very robust tool to help employers make better decisions."

Access to the data is currently confined to Blues plans. Officials said consumers would not have direct access, but would benefit through data included in published reports and studies. Research comparing drugs would be published, Plocher said, but drug data won't begin to come into the database until the middle part of next year.

Twenty of the nation's 38 Blues plans are taking part. Blue Cross-Blue Shield Association President Scott Serota said he hopes all plans will participate, "but we have to sequence it. We can't load all the data at once."

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