Faculty, Part 1: Barbara J. McNeil, Bruce Landon
Affiliated Faculty: David Blumenthal
Faculty, Part 2: Barbara J. McNeil
This project has two parts. The first involves reviews of approximately 40 to 50 programs per year that are being undertaken by Blue plans throughout the country. These programs are designed to improve quality of health care and/or decrease associated costs. The HMS team ranks the programs using an NIH scoring system. Our judging criteria include innovative program design, good generalizability to other Blue plans, and potential impact on health care cost and quality.
A primary reviewer assigned to a program submission leads the discussion in a summative judging meeting, during which all submissions are discussed and one or more programs are selected for the BlueWorks honor. The winning program or programs and their merits are later contextualized and summarized for colleagues at the BCBSA. Selected winners in each year are further honored at the annual BlueWorks Summit, held during the “Distinctively Blue and Focus on Providers” conferences in Chicago. Sample winning topics have included e-prescribing, an innovative diabetes-management program, and web-based tools for plan members to more actively participate in their own health care. HCP’s Bruce Landon has addressed recent conferences about general issues in health policy, as well as about our approach to vetting the programs.
The second part of this project involves evaluation of programs and investigations by Blue Cross plans to combat fraud. We annually evaluate the details of several programs and investigations to identify those that are most innovative, effective, and generalizable to other Blue plans. In the case of investigations, we also consider the extent to which the investigations have led to substantial financial settlements or conviction, as well as the quality of investigative techniques used. These winning BlueWorks submissions are honored and discussed at BCBSA’s National Internal Audit and Anti-Fraud Conference Recent winning programs have included a health plan associate education program, a novel internal audit procedure designed to close fraud and abuse loopholes in plan policy and procedure, a narcotics abuse and trafficking case, and fraudulent billing for back pain treatments using inappropriate treatment codes.
