I bet this has happened to you:
You need to go to the doctor, your regular doc is unavailable (maybe he retired, took a vacation, changed jobs, whatever), and now you have to see a new doctor, possibly one in a different clinic or organization. And the QUESTIONS begin.
“So, tell me about your health conditions?”
“What drugs are you on?
“Do you live alone?”
“Any pets in the house?”
“What shots did you get last year?”
My goodness! How many times do I have to answer the EXACT same questions? Again? Harumph!
How would you like it if every doctor or hospital you visited – whether they are in the same healthcare system or not – could quickly and easily see your total medical records, and a big chunk of those questions went away? Yeah, me too!
The Future Is Epic
Here at Blue Cross, we’ve been working hard and making very big investments in standing up a tool that has the potential to allow that exact scenario. The setting up of Epic’s Payer Platform puts us peer-to-peer with the more than 70% of the medical providers in Louisiana our members already go to for care. That means most of the clinics and hospitals across the state now can easily see health records for Blue Cross members (their patients).
How do we have access to so much health data? Well, when you think about it, the only thing that all docs and hospitals you go to for care have in common is that they bill Blue Cross for treating you. That means they must communicate with us to get paid. They do this by submitting claims that show what they treated you for and which services you needed. That claims data gives us, as the health insurer, the BEST repository of your medical records, stretching across providers. It doesn’t matter which health organization your doctor is in, or even if you had an emergency and needed care while out of town – it will all eventually hit our system in the form of claims.
If your doctors see our data, which includes claims history, lab results, pharmacy benefits and other clinical information, they have a better idea of what care you got outside of their clinic and are aware of any past diagnoses or procedures you had. If you work with the Blue Cross care team and those clinicians have feedback, especially if they’re helping you with long-term conditions or serious illnesses or injuries, we can make a note for your doc. Then they are better prepared to address all your needs when you go for an appointment. And, our talented team, with nationally recognized capabilities and proprietary technology, are turning the data into timely, actionable insights that make it even more useful for your healthcare provider – collaboration that drives better health outcomes and helps keep costs in line for you.
This exchange is happening almost seamlessly now through a secure, electronic medical chart, instead of relying on you to pull it out of your brain on the spot by answering a lot of questions. Much easier to let the system keep track of it, right?
That’s how being able to securely share that information with your healthcare providers not only helps us work together more effectively, it makes it easier for you to get the care you need. We can even help connect you with a health coach or with programs and services in your community (like help with transportation, finances or meal delivery) – during that same appointment!
But it’s not very easy for Blue Cross and our network providers to share data to help treat you if our platforms and theirs don’t speak the same language.
By Blue Cross, as the health insurer, making the move to shift our clinical and provider network services to Epic, we’re unlocking the potential to cut WAY down on the questions you have to answer every time you go to the doctor. We are now able to share up to three times more information with your healthcare providers than we ever could before, when we were all using different systems and software.
It took a lot of time, money and effort to get us here, but we successfully made the shift to Epic in late April. We’ve moved our Care Management and several other processes to Epic, and we are live in more than 500 providers’ offices, able to exchange data on more than half our members. We’ll be transitioning more processes and setting up more provider connections through the end of the year to give more of you the Epic advantage.
How Does Better Tech Lead to Better Healthcare?
In the 17th and 18th centuries, France became so important on the world stage, especially in Western civilization, that other countries sought to emulate their government, their military, their tax structures, and their prowess in trade and treaties. In fact, for hundreds of years, when diplomats from other countries got together, the only language spoken was French. Handed down to us in 2024 is the concept of “lingua franca,” essentially to mean the language used in a particular setting.
Today, the lingua franca of the medical world is the electronic medical record. When you need a very expensive, complicated or unusual medical procedure, your providers and insurance company need to be in lockstep. It makes it easier for you, the patient/member, to focus on your health and the procedure you need if we are communicating constantly, on the same platform, to make sure you’re getting the exact right care, at the exact right time, in the exact right setting.
Again, it’s pretty hard to pull that off if the provider and insurance company aren’t on the same page when it comes to your medical records and condition. The process we go through to make sure your providers know that the clinicians on staff at Blue Cross agree with their treatment plan and that they will be paid for treating you BEFORE they provide your care is called “prior authorization.” This process allows us to make absolutely sure that before we spend YOUR premium dollars on care, that the care makes perfect sense based on your current health needs. This also helps eliminate back and forth between your insurance company and the providers later. Everything is outlined and agreed upon up front.
Historically, the prior authorization process has been slowed because the many electronic medical record systems that providers and insurance carriers use often didn’t speak to each other. This could mean a lot of person-to-person phone calls, doctor peer-to-peer reviews, and information going back and forth on emails and yes, even fax machines, to get to an answer we could all agree on. In some cases, our care team had to go to providers’ offices and look at paper charts to gather information. Pretty wild to think about that still going on in the digital age, right?
With Blue Cross and the providers all using Epic, there will now be more and better clinical data in your health records. That will make it faster and easier for us to go through the prior authorization process on your behalf – it will take less time and coordination to get on the same page.
Why Do We All Use Epic?
In the past decade or so, the electronic health record providers have consolidated, some have left the market, and the last product standing will probably be Epic. That’s why this is the platform that most hospitals and docs are using.
Epic, an independent company, is a significant investment we’re making to transform and upgrade our technology. And learning to move a bunch of processes and records that used to live in different places into one platform takes time. In fact, many smaller provider practices have allowed themselves to be acquired over the past few years by larger providers who already had Epic in place. They simply could not afford to buy an electronic medical records platform and set it up themselves, then train everyone on the care team to use it.
And now, your Blue Cross plan is also on board, streamlining all these approvals and making absolutely sure every provider who treats you has ALL of your medical data, even if it was gathered from providers outside the healthcare system you regularly go to.
The Straight Talk is, YOUR Blue plan has made the investment in money, talent and time to get Epic up and running. Today, in the world of electronic medical records being the backbone of healthcare, the “lingua franca,” the system we are all going to use will be Epic. And we are rapidly moving to all speak the same language so we can provide you the best care in the best setting at the best price.
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