Medicare Compliance & Reimbursement

It could promote quality care nationally, but it could also violate HIPAA.

The Blue Cross and Blue Shield Association (BCBSA) has come out with a new product that leverages 79 million members' claims data. It's called Blue Health Intelligence (BHI), and the Blues Association hopes their new database will help participating plans grab market share by providing employers with what they want most: benefit packages that maximize healthy outcomes and minimize costs.

BHI is so promising because of the Blues' nationwide reach. It will provide an unparalleled depth and breadth of information about a range of healthcare trends, says Gail K. Boudreaux, Health Care Service Corporation's executive vice president and BHI board co-chair, in a conference call. This will allow employer customers to tailor benefits to specific employees' needs in a much more granular level than is available anywhere today, she adds.

BHI's creators also bank on it having an impact on national health care quality. "As it is more fully developed, it will provide great insights for consumers, providers and employers about the quality of service rendered at various institutions across the country and more importantly benchmark the kinds of services they are providing against other institutions in other markets," says BCBSA president and CEO Scott P. Serota.

Privacy Advocates Raise The Battle Flag Over BHI

BHI's national scope has caught privacy rights advocates' attention. Since the House passed their version of an electronic health records (EHR) bill late last month (HR 4157), these advocates have renewed concerns about who owns medical records, who gets to see them and who gets to sell them. BCBSA's unveiling of BHI nearly coincided with the House bill. The Patient Privacy Rights Foundation is one group that has come down hard on BHI even though BCBSA contends that BHI complies with the Health Insurance Portability and Accountability Act (HIPAA) and excludes personal identifiers. Patient Privacy Rights links EHR and BHI and asserts that profitability will clash with privacy as BHI evolves.
 
"This craven move by the Blues reveals what Americans can expect from an electronic health system because they no longer have the right to control access to their medical records," says Deborah C. Peel, MD, founder and chair of Patient Privacy Rights in a press release.

"Sensitive health records will be used for corporate profits and in ways that can directly harm them," Peel continues. And her organization makes the case that there's money in data mining. IMS Health sold prescription data for revenues of $1.75 billion in 2005, and the American Medical Association (AMA) sold physician databases for $44.5 million in 2005. Takeaway: If you plan on signing onto BHI or a competing data aggregation service, you may need to craft standards even tougher than what the government mandates or prepare for a fight with privacy activists.