Tennessee Blues plan launches online health records project

In what it says is an effort to improve care, increase patient safety and reduce costs, BlueCross BlueShield of Tennessee in May rolled out a multimillion dollar initiative to make medical records of all its members available to physicians online. That includes patients enrolled through the state of Tennessee's troubled Medicaid alternative, TennCare.

Under its Community Connection initiative, the insurer mined and stored clinically relevant information from health care claims in a database. Physicians can access it securely over the Internet while their patients are in their offices.

That database will help the health plan improve care and reduce costs by giving physicians access to information about patient care that occurred in other physician offices or hospitals, said Jana Skewes, president and CEO of Shared Health, a for-profit company that the plan created recently.

"What we've done is taken claims data and built a database with data that is meaningful to clinicians at the point of care," Skewes said.

For example, physicians who sign up for the service, which is free, will be able to access test results, medications, hospital visits and emergency department visits. They also will be able to see whether patients are complying with drug regimens, based on the frequency patients refill prescriptions, and can avoid ordering duplicate tests and adverse drug events because they will know what other doctors have ordered. They also will be better able to spot patients seeking to acquire narcotics illegally.

The first phase of Community Connection, which started this month, involves recruiting the 13,000 to 14,000 doctors who treat patients enrolled in TennCare, the state's financially troubled Medicaid managed care plan. The state is trying to cut 25% of members off the TennCare rolls to save money, as well as cracking down on fraud associated with the program.

The Chattanooga-based Blues plan is the largest of the seven insurers in TennCare, which has 1.3 million members. Participating doctors initially will only have access to data on about 740,000 TennCare enrollees, but the Blues plan expects that data on all enrollees will be available by fall. The health plan also anticipates that its service will cover the more than 2 million members in its commercial insurance products in early 2006.

Shared Health, which is investing $30 million in the project over a three-year period ending in 2006, plans to offer Community Connection free to the state for one year and then charge a per-member-per-month fee. The company also plans to charge a fee to other insurers in TennCare that participate in Community Connection.

Although that service is free and participation is voluntary, participating physicians will need to have a high-speed Internet connection, said Tim Haynes, manager of community development at Shared Health. The Blues subsidiary eventually plans to sell the service nationally to other insurers, Skewes added.

Edward Capparelli, MD, a family physician in Newport, Tenn., who helped test a prototype of the system, finds the service helpful. For example, he has seen that some patients are refilling 30-day prescriptions every 45 days. "It helps me to take better care of the patient because we have a better picture," Dr. Capparelli said. "I'm not dependent upon either what the patient tells me or what my chart reflects, because what my chart reflects I told them to do and what they actually do may not be the same."

The Tennessee Medical Assn. could not comment because it didn't know the details about the Blues' initiative, a spokesman said.

The Blues hopes its initiative will help encourage physicians to adopt electronic medical record systems. "In Tennessee, only 10% to 11% of physicians have EMRs," Skewes said. "We hope that this will be a first step to get those physicians who don't yet have EMRs to at least get [Community Connection] as a foundation tool."

The insurer does not view its technology as an alternative to replacing or competing with EMRs because at some point doctors will need both clinical as well as the claims-based data it is offering. "If they want to have at their fingertips a lab result that was taken yesterday, they will only get that through an EMR," Skewes said.