ACADEMIA

ViPS, a provider of healthcare business intelligence solutions, today announced that BlueCross BlueShield of Tennessee is realizing returns of more than $2.25 for every dollar it has spent on implementing ViPS' MCSource, the company's premier care management decision support solution. "After conducting a rigorous return on investment (ROI) analysis, we realized just how impressive the study's findings were in terms of ROI and expect this level of return to continue," says Allen Naidoo, PhD and senior manager of health services research at BlueCross BlueShield of Tennessee, based in Chattanooga. BlueCross BlueShield of Tennessee, the largest managed healthcare organization in Tennessee, serves more than 4 million people and supports multiple lines of business, including Medicare and Medicaid (the state's TennCare program). It launched its implementation of MCSource early in 2001 and went "live" with the product in May 2002. "MCSource has really been an asset for us," Naidoo states. "It has allowed our analysts to do their jobs, answering business questions rather than always writing programs and extracting data from our operations." As a single-source, enterprise-wide solution, MCSource produces analytical information to aid in business operations, strategic planning and improvement of patient care. MCSource's vital foundation is a high-performance data warehouse that consistently reformats and edits data that are stored in different ways and in different applications. The system can generate clinical, provider and financial analyses based on all the data in a managed care organization's systems, whatever its location or format. BlueCross BlueShield of Tennessee undertook its ROI analysis to help justify the MCSource implementation to its management, as well as to guide its future use of the product's features. According to Judy Slagle, director of health information and reimbursement at BlueCross BlueShield of Tennessee, "When we looked at the ROI model we took all of our costs, including our salary costs, as completely into account as possible. We wanted a really comprehensive picture of both the costs and benefits." Moreover, BlueCross BlueShield of Tennessee has only begun to take advantage of the opportunities presented by MCSource. "We haven't fully tapped its potential," Naidoo says. The first components of MCSource to be implemented were the simplest - tools that allowed BlueCross BlueShield of Tennessee to generate versatile reports using MCSource's Episode Treatment Groups(TM) (ETGs)-based methodology that accurately assigns all healthcare claims data, regardless of origin, into episodes of care. The plan shared the resulting practice pattern analysis (PPA) with its care providers. "We have a lot of information in our databases, and now we're making it more available to them, giving them a new set of metrics," Naidoo adds. In the future, he says, BlueCross BlueShield of Tennessee will use MCSource to move toward the "next generation of care management, using predictive modeling to risk-stratify members so that these individuals receive the appropriate levels of care." In fact, Naidoo notes one of MCSource's earliest benefits to BlueCross BlueShield of Tennessee was the fact that the organization's data, widely distributed through different databases and formats "had not been through a thorough scrubbing process." Implementing MCSource initially allowed BlueCross BlueShield of Tennessee to eliminate errors in these data and put them all into a common format for easy sharing by different applications. ViPS President and CEO Jenny Morgan observes that, "BlueCross BlueShield of Tennessee has collected hard, persuasive data showing that an investment in a large, highly capable clinical data warehouse can generate true ROI in a relatively short time. BlueCross BlueShield of Tennessee approached this implementation in just the right manner, beginning with an early recognition of the need for a solution like MCSource. They judged MCSource by both financial and clinical standards, and the software has delivered on both counts."