Claims Data Analytics: The Challenge of Modern Healthcare

A healthcare benefits claim form.

The Blue Cross Blue Shield (BCBS) and Blue Health Intelligence (BHI) claims data analytics challenge has now been reduced to five finalists, all of whom have found ways to leverage data analytics to improve access to medical care and enhance the patient experience.

The contest was created to find innovators capable pulling actionable insights out of large volumes of healthcare claims data. Finalists now get the chance to advance their ideas using a dataset from BHI’s database of more than five billion covered procedures performed each year. The medical claims data comes from more than 170 million active and inactive BCBS members.

Using that data, the finalists will have the chance to improve and refine how their ideas would work in making insurance claims processing more effective and efficient.

Can Data Analytics Reduce Healthcare Costs?

Why is the BCBS and BHI contest important to the healthcare industry? Primarily because it puts analytics at the center of the push to improve the quality of healthcare while also making services more cost efficient.

This use of data analytics with population health issues is relatively rare, according to a recent survey reported on by Health IT Analytics. While healthcare organizations try to make the most of data by applying it to clinical care, few have “mastered the challenges of data-driven population health management.”

Instead, most organizations are comfortable using data for financial and operational improvements and decisions, with 58% of those who responded to the survey saying that financial issues are their top priority with data.

That makes the work being done in the claims data contest of interest. It can apply to population health as well as improve healthcare delivery and save money.

The Finalists in the Contest

These are the five finalists in the contest and an outline of their projects.

Livongo

This plan calls for using tech tools to help those with chronic conditions to “live better, healthier lives.” Livongo plans to leverage the BCBS dataset to identify, predict and prioritize members who may struggle with medication adherence, which involves not taking prescribed medicine as directed.

Pager

This involves the creation of a system that will serve as a collaboration hub between patients and healthcare teams. Connecting patients to providers through chat, voice and video features, the company intends to use the BHI dataset to determine how to best enhance patient “journeys through their healthcare usage.”

Thrive Earlier Detection

The focus here is on getting earlier cancer detection worked into routine medical care. The company is developing CancerSEEK, a liquid biopsy test which can detect cancers at the earliest stages. They plan to use the dataset to get more accurate information on the health and economic impacts of earlier cancer detection.

Wildflower Health

Wildflower Health focuses on software for families during pregnancy and in relation to pediatrics. They plan to use the database to improve the risk-stratification model for their pregnancy platform.

Workit

Workit specializes in opioid addiction treatments. The company plans to use the database to find more “holistic and comprehensive ways” to measure addiction treatment success.

The finalists have two months to do their data analysis. The winner will receive access to a subset of BHI data for six months, consulting support from BHI, access to BCBS leadership as well as mentorship and advice from BCBS companies’ and leaders from the Health Information and Management Systems Society (HIMSS).

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Academic Calendar

SUMMER 1 – 2021

Application Deadline April 16, 2021
Start Date May 3, 2021
End Date June 27, 2021

SUMMER 2 – 2021

Application Deadline June 11, 2021
Start Date June 28, 2021
End Date August 22, 2021

FALL 1 – 2021

Application Deadline August 6, 2021
Start Date August 23, 2021
End Date October 17, 2021

FALL 2 – 2021

Application Deadline October 1, 2021
Start Date October 18, 2021
End Date December 12, 2021

SPRING 1 – 2022

Application Deadline December 17, 2021
Start Date January 10, 2022
End Date March 6, 2022

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