Clinical Data Exchange – Report Card BlueCross BlueShield of Tennessee

BIOGRAPHY Emily Bagley Director, Advanced Accreditation Analytics and Provider Data Solutions BlueCross BlueShield of Tennessee Responsible for direction and oversight of analytics and reporting, consultative services, and clinical data exchanges with providers Manages the strategic and account planning processes to optimize provider satisfaction and accreditation outcome measures Oversees the team that supports the Tennessee Health Care Innovation Initiative Contact Info: Phone: (423) 535-7046 Email: emily_bagley@bcbst.com

BIOGRAPHY Deana Hixson Business Systems Analyst BlueCross BlueShield of Tennessee Responsible for clinical data exchange provider partner outreach and onboarding Assistance with support and maintenance for clinical data exchange Contact Info: Phone: (423) 535-7014 Email: deana_hixson@bcbst.com

Clinical Data Exchange (CDE) – Need Identified Gaps in care are identified for members with certain indicators for a condition or disease state Many gaps in care cannot be closed by claims information alone; a small number of our Tennessee providers routinely use CPT-2 codes The claim only tells part of the story – more transactional All gaps in care begin as gaps in information – filling in the blanks with clinical values Obtaining clinical data through non-claims sources provides Greater visibility into the member’s care Reveals either compliance or Actual gaps in care for the provider and member to close. 4

Supplemental Data Additional Data through Supplemental Sources Data through Claims Demographic information Provider information Diagnosis Procedure Prescriptions Date of Service Additional Data through Supplemental Sources Lab values Vital measures (BP, BMI, etc.) Test values Allergies Immunizations Clinical notes Medication Adherence Family History Social History

Clinical Data Sources Hospital Data Admissions/Discharges/Transfers Primary Care Physician Immunizations Vitals Family History Pharmacy Data Prescriptions Medication Adherence Lab Data Test Results Lab Values EMR Data Patient Notes More Diagnoses Claims Data Procedures Diagnosis Utilization / Tests Specialist Data Episodes of Care Consumer Data Device Integration Third Party / Consumer Segmentation

Clinical Data Exchange - Background Started in 4th Quarter 2014 Prioritized our provider partners by the following criteria: Participation in a Valued Based Program Strategic Partner High volume of BCBST members Receive clinical supplemental data from our provider partners Support efforts to improve HEDIS and STARs quality outcomes scores Support quality payment programs and risk-sharing arrangement efforts

CDE – Current and Future State 27 provider groups exchanging 16 use a vendor, 11 exchange directly with us 17 send CCD, 10 send flat files 3,000+ Total providers, 800+ are PCPs 153,000+ Commercial members, 80,000+ Medicaid members, 22,000+ Medicare members 3 more in testing phase scheduled to be exchanging by end of 2017 10 hospital facilities admission, discharge, and transfer (ADT) records from a regional health information exchange Future: 10 more provider groups targeted in 2018 8 currently in discussion phase 3,500+ Total providers, 400+ are PCPs 50+ facilities for ADT records

Clinical Data Exchange – Report Card Identified ways to improve the process as the program matured Developed a CDE Report Card to: Monitor data received Validate the value it brings to each group Identify potential issues in a timely manner

Clinical Data Exchange - Report Card Purposes CDE Report Cards are produced for each provider group that is currently exchanging EMR data on monthly basis to ensure consistent and complete clinical data exchange is occurring. This tool is available for evaluating a provider’s status in a value-based payment program. The CDE Report Card has the following sections: High level summary Lab data Office visit data HEDIS value sets QCR report card Executive summary

CDE Report Card – High Level Summary Each month all provider group’s CDE exchange is measured for completeness and accuracy of information.

CDE Report Card – Lab and Visit Sections Lab and Visit sections tell us frequency of data exchanges as well as ensuring each LOB is currently being included. Commercial
 Medicaid+
 Medicaid
 Medicare Other For demonstration purposes only. Does not represent actual BCBST data. 

CDE Report Card – Measure Impact HEDIS Value Set section shows how CDE impacts on an individual measure by measure basis. For demonstration purposes only. Does not represent actual BCBST data. 

CDE Report Card – Program Impact QCR report card section shows for highly impactible HEDIS measures how much penetration CDE makes into those attributed members on their report cards. For demonstration purposes only. Does not represent actual BCBST data. 

CDE Report Card – Practice Status An executive summary document for all groups is compiled each month to display CDE status and issues needed to resolve to move a group from Yellow/Red CDE status.

CDE Report Card - Results The Clinical Data Exchange Report Card is a critical component of the CDE program to proactively identify and address potential issues early in the process once we begin to receive the first production files from each provider group. The proactive nature of the CDE Report Card allows us to manage the Value Based Programs more effectively. If lower than expected member matching rates are identified, we begin researching the issue. We see a direct correlation with specific measures for provider partners with high matching percentages compared to their outcomes scores for the quality programs they participate in.