Specialty Care Insight Program

Blue Cross and Blue Shield of Louisiana is implementing the Specialty Care Insight program to make information about cost and quality more transparent to our providers in our network. Through this program, Blue Cross will give physicians in certain specialties data that can help them identify effective strategies to reduce over-utilization of low-value, high-cost services where they may exist, while assessing quality-of-care metrics.

Blue Cross has partnered with CCGroup, Inc. for this data. CCGroup, Inc. is an independent company that provides analytical tools for Blue Cross and Blue Shield of Louisiana and its subsidiaries. CCGroup has developed an analytics tool that can generate practice-level reports on several important attributes that may help a practice identify overuse of low-value, high-cost services and reduce these instances to drive use of high-value, cost-effective services. The analytics also help identify underuse of potentially beneficial, high-value services so that practices may review their patterns of care delivery.

Each practice’s Specialty Care Insight Report will:

  • Organize medical conditions commonly treated in that specialty, called “market basket” episodes, into Severity of Illness (SOI) categories to profile both quality effectiveness and cost efficiency. The market basket contains only episodes that are commonly treated and represents standard practice for that specialty, with the more complex, outlier cases eliminated from the analytics.
  • Provide data that indicates over-utilization of high-cost, low-value diagnostics and/or therapeutics that tend to drive higher costs.
  • Indicate quality measures appropriate for the specialty’s market basket episodes that can prevent under-utilization of essential services.

The report’s data is unique in our market, in that the targeted specialties can see their impact relative to their peers across the entire care spectrum for medical conditions most commonly treated by that specialty.

See Frequently Asked Questions about the Specialty Care Insight Report and examples of medical conditions by specialty for:

SCI Target Specialties

Blue Cross will engage at least four specialties in this program in 2014. The first two specialties that will receive Specialty Care Insight Reports are cardiology and orthopedic groups in the Blue Cross network.

Later in 2014, Blue Cross will select additional specialty groups to include, likely choosing from among gastroenterology, ear/nose/throat, obstetrics/gynecology, urology and/or neurosurgery/spine surgeons. After the initial year, more specialty types may be included.

Blue Cross will conduct training to help the participating specialty groups understand the reports. Live webinars will be offered for eligible providers in each region and specialty selected, to explain the need to create this program, and how providers can glean actionable data from their reports.

Blue Cross aims to meet with the Louisiana professional chapters/societies and groups for participating network physicians in the specialties selected to get their feedback about what are included as market basket episodes and measures for that specialty, and the usefulness of the cost and utilization data the reports provide.

If a medical condition or quality measure is added, altered or deleted based on these discussions, the reports will be modified prior to the mid-year update that is planned for later in 2014.

Blue Cross will share additional information about the Specialty Care Insight program as it progresses.

Contact Information

Providers who have questions about this program can contact Blue Cross Network Development at network.development@bcbsla.com or 1-800-716-2299, option 1.