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December 5, 2005 - For the past 15 months, Blue Cross Blue Shield of Vermont (BCBSVT) has been using RPNavigator, a web based decision support tool offered by CareAdvantage, Inc. Through the use of RPNavigator, BCBSVT has been able to improve quality of care, effect savings, and enhance its attractiveness in the health insurance marketplace.
By leveraging the predictive modeling capabilities available through RPNavigator, BCBSVT is able to enhance care coordination by proactively identifying actionable, high-risk members whose health status can be improved through member education and behavior modification. “The program has increased the number of high opportunity members that are assessed, as well as member and provider satisfaction,” said Susan Nicholls, BCBSVT’s Director of Medical Services. Don George, BCBSVT’s VP of Managed Care Systems, added that, “CareAdvantage is an important business partner of BCBSVT. RPNavigator’s enhanced decision support capabilities are strengthening our position in the market and our ability to improve quality of care and contain costs.”
In addition, BCBSVT uses RPNavigator‘s reports and analyses for client retention and sales growth purposes. These reports streamline internal operations by helping to more effectively implement care management programs on an employer-specific basis. “The enhanced reporting capabilities of the system provide our organization with a unique ability to meet the data transparency needs of the marketplace,” said David Krupa, BCBSVT’s VP of Sales and Marketing. “This enables us to have more productive discussions with our customers with respect to measuring outcomes, improving quality of care, and containing medical costs.”
BCBSVT also uses RPNavigator to support its credentialing and profiling efforts. Profiling is performed for primary care providers, as well as specialty providers. The provider’s performance is reviewed by external benchmarks, HEDIS requirements and clinical practice guidelines.
The Blue Cross Blue Shield Association selected BCBSVT as one of three BCSB plans in the country for a pilot project in care coordination. BCBSVT is using RPNavigator in its care management program to provide focused interaction between case manager and member/provider, uncover atypical utilization patterns, support quality improvement initiatives, and compare provider performance with peers. Other accomplishments include the achievement of $5.1 million in program savings.
BCBSVT has been a CareAdvantage client since 1996, during which time CareAdvantage has provided it with a variety of medical management services, including an onsite Medical Director and Director of Operations.
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