- The BCBS payor world has extremely complex systems that are full of raw data. The data needs to be accurate, timely and insightful to facilitate patient health status and care. RJ Health Systems’ services can help improve the accuracy of the claims and the historic data that is analyzed for patient and population health.
- Payors need to improve their patient care models to proactively identify care opportunities and monitor patient progress. RJ Health Systems has an ICD-10 solution to identify and validate appropriate drug treatments based on diagnosis and flag questionable treatments for care follow-up.
The Blues Information Management Symposium (IMS) was hosted recently by Florida Blue at the Ritz-Carlton in beautiful Amelia Island, Florida. The Blues IMS is an annual conference started in 2000, presented and hosted by different Blue Cross Blue Shield (BCBS) Information Professionals every year. Most recently, Blues IMS was hosted by Excellus BlueCross BlueShield in 2014, Arkansas Blue Cross and Blue Shield in 2013 and BlueCross BlueShield of Tennessee in 2012. The purpose of the IMS is to provide BCBS Plan business and technical representatives an opportunity to network and exchange best practices and innovations in the field of information management, information architecture, data warehousing, business intelligence, informatics and analytics with the end result of delivering actionable business value to the Plans through the power of information assets. RJ Health Systems, being the most trusted provider in specialty in medical pharmacy intelligence, was the perfect fit for sponsorship at this year’s Symposium. RJ Health Systems was a platinum sponsor, which provided an opportunity to present on how to Manage Specialty Drug Trend. Randy Falkenrath, Customer Advocacy Advisor, engaged with a focused audience on how much more difficult the medical benefit is to manage for Information Technology. Attendees agreed that there was a need for NDC level data. NDC level information refers to pricing and coding data that is specific to the individual NDC number referenced. In contrast, HCPCS drug Code level information is data that relates to the HCPCS drug code. More and more of the BCBS plans are moving away from HCPCS/CPT® codes to report on drug information and utilization at NDC level. A complete and accurate NDC crosswalk was identified as the next greatest tool that all plans need to integrate into their systems. Along with the need for NDC level data, there were two major themes that were discussed frequently by keynote speakers and plan attendees: