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Blue Cross NC’s future will be shaped by sharing large amounts of data

Blue Cross Blue Shield of North Carolina says the future calls for sharing data about patients to save costs and lives.
Blue Cross Blue Shield of North Carolina says the future calls for sharing data about patients to save costs and lives. cliddy@newsobserver.com

Imagine you are sitting at your desk one morning, and you have just received some distressful news about your company — a high-level data breach, for example.

You start to feel some tightness in your chest because of the magnitude of the news. Then your arm starts tingling. A few minutes later, your smart watch has sent you a notification that your heart rate and blood pressure levels are not normal. Minutes later, you go into full cardiac arrest.

But already, steps were being taken to give you medical attention. Your smart watch has already called 911 and reached out to your coworkers. It’s reached out to your emergency contacts and your primary care doctor. Your coworkers, who were just notified, have called for help, too, and a drone is on its way to deliver a defibrillator that saves your life.

That rapid reaction isn’t a reality now — where health data is shared seamlessly among multiple parties in actionable ways — but it could be soon, said Patrick Getzen, chief data and analytics officer for Blue Cross Blue Shield of North Carolina.

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Patrick Getzen, chief data and analytics officer for Blue Cross NC Courtesy of Blue Cross NC

“We are pretty close to getting there,” he told the North Carolina CEO Forum Tuesday. “Your watch can already monitor biometric changes. Drones are already delivering AEDs today and your watch could call 911, too, though policy is holding that back.”

That is just one way that technology could change the way we manage health care, Getzen said — and Blue Cross NC, the state’s largest insurer, plans to be at the forefront of whatever may come.

“Technology is impacting people’s lives,” he said, “but what it is going to be used for in North Carolina is to transform health care.... We don’t want to be on the sidelines [as that happens]. We feel an obligation to lead it.”

But that will require intense collaboration among insurance companies, health care providers and the businesses that both use their services and are on the forefront of technological advances themselves.

Sharing data about patients

One of the biggest ways those groups will collaborate is by sharing massive amounts of data about patients. Already, Blue Cross NC has partnered with five of the largest health care providers in North Carolina under its Blue Premier program to share data — and Getzen said two more partnerships are coming.

Under Blue Premier, Blue Cross NC will be able to share patients’ data with the participating providers, like UNC Health Care and WakeMed, a move that should help doctors see all the care a patient has received, potentially eliminating expensive and redundant procedures.

The ultimate goal is to create a 360-degree view of a patient, so that every doctor has all the information they need to make the best decision for the patient.

And as Blue Cross NC becomes more sophisticated in how it uses and shares data, it should be able to make more predictive health care choices for patients, keeping them healthier and costs down.

“We have data that goes back decades,” Getzen said. “It is robust and longitudinal.... We can leverage insights in ways we haven’t before.”

That could mean using machine learning and artificial intelligence to predict who might need a heart transplant or knee replacement, or simply matching the best doctor with a particular patient.

How to protect privacy

It could mean creating a smooth pipeline of interaction between all the steps of care. Currently, you can find an in-network doctor through a Blue Cross NC portal, but to make an appointment you have to go through the doctor’s website. What if there was just one portal for everything, Gretzen mused.

Making strides in advanced data and other technology advances has become a huge priority for Blue Cross NC. But, with the resignation of former CEO Patrick Conway earlier this year, the company has lost the person who was spearheading that effort.

Conway’s resignation, following a drunken-driving incident, led to the termination of a potential merger with Cambia Health Solutions, a large insurer in Oregon. That deal was partially signed to share loads of data between the two insurers, who each covered around six million people together. (Conway was not mentioned by name by either Gretzen or Gerald Petkau, the insurer’s interim CEO, during the CEO Forum.)

However, to ultimately facilitate this change, government regulations need to keep apace, especially around how sensitive data is handled when it is shared by so many people.

“We have to address privacy concerns. No one has come up with policies to do that effectively yet,” Gretzen said, noting that less than 40% of health organizations can share data effectively.

“We have to build these pipes to exchange data, But the data has to be highly accurate and highly trusted and delivered immediately,” he said. “These rules have not been written yet.... Regulation tends to lag behind so we need to make sure that our policy makers in North Carolina are awake and ahead on this.”

This story was produced with financial support from a coalition of partners led by Innovate Raleigh as part of an independent journalism fellowship program. The N&O maintains full editorial control of the work. Learn more; go to bit.ly/newsinnovate

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Zachery Eanes is the Innovate Raleigh reporter for The News & Observer and The Herald-Sun. He covers technology, startups and main street businesses, biotechnology, and education issues related to those areas.
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