1. Clinical Data Exchange – Report Card
BlueCross BlueShield of Tennessee

2. 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)

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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. 

13. 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. 

14. 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. 

15. 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.

16. 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.