Blue Cross tracks financials with MEDecision

FRAMINGHAM (03/25/2004) - Blue Cross Blue Shield of Massachusetts (BCBSMA) expects an "eight-to-ten-digit type of savings" with its recent implementation of MEDecision Inc.'s CarePlanner Repository Information System (CRIS), according to BCBSMA CIO Gary Austin.

CRIS, implemented in November, allows BCBSMA nurses to monitor patient disease states and related financial activity. The system is currently being used by 200 nurses, and Austin expects it to eventually be used by 500.

"We were primarily focused on just the financial management side (for patient care) and had to transition over to the health management side, because as an insurer we need to do whatever we can to make people more healthy and reduce costs," Austin said.

CRIS is supported by a client/server operating system, and BCBSMA will switch to a Web-based platform next month.

Nurses enter patient information into the CRIS on desktop computers and tablet PCs. The CRIS provides nurses with a long-term view of a patient's history. Comprised of built-in algorithms, tracking patient history, symptoms, and conditions, CRIS allows nurses to quickly determine if a patient should be in a specific disease management program.

"This type of data was previously used only for referrals," said Austin. "By using it on the medical side, we are able to gauge what a patient may need to improve his or her condition. It is a way of keeping them healthy, managing the health system, and industrializing healthcare processes for our members."

Austin said MEDecison has helped BCBSMA save time in providing patients with disease management information, although he noted it is too early to quantify results because the system has been operational for only a few months.

BCBSMA previously used a "series of point solutions" to monitor patient disease states in a hard-copy tracking system. This system allowed nurses to determine a patient's needs, based on condition, but it was not allowing them to be completely efficient, said Austin. "Our old system required too many manual processes. A lack of automation slowed things down," the CIO added.

One drawback to CRIS is that nurses currently cannot run patient reports at the point of care. By the end of June, Austin said, nurses will be able to run reports at the point of care and transmit patient information to CRIS in real-time.

Pricing for MEDecision's CRIS begins at US$100,000, including licensing and software.

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