What it Takes to Make Health Care Work
For members, a health condition or emergency shouldn’t have the added stress of complicated administrative factors, unpredictable costs, or difficulties in accessing needed care. At BlueCross BlueShield of Tennessee, we take to heart the needs of our members and continue to add new, more convenient and cost-effective ways to access high-quality, affordable care and treatments.
While helping individuals and families navigate their immediate health needs throughout 2021, we worked to address their longer-term health with opportunities for them to take a more frequent, active role in their care. We continued to make telehealth sessions easy and affordable for routine health visits, seeing high satisfaction scores and utilization rates for this covered benefit.
For those who value in-person visits, we strengthened easy access to care by expanding the number of our BlueCross Medical Centers, operated by Sanitas, to eight fully staffed clinics located across the state. Our clinics encourage a whole-person approach to member care needs – along with the added advantage of convenient same-day care so that immediate or chronic condition needs can be met quickly and appropriately.
And for members needing specialty pharmacy treatments, we successfully helped reduce those drug costs by nearly 15% to drive real pharmacy savings and reductions in premium costs for members and group customers.
Making Quality Count
Our quality scores and member satisfaction ratings continued to meet or exceed high standards. In 2021, BlueCross earned and offered group customers and plan members the state’s only 4-STAR commercial PPO plan. And our Medicare Advantage PPO earned an outstanding 4.5-STAR rating, based on more than 40 different quality and performance factors.
In total, our work in 2021 centered on our members, their care, and driving positive engagement and interactions to benefit healthy outcomes.
We stand behind our mission-driven approach to serving our members in ways that support both their health and their personal finances. And we demonstrate our commitment to our customers and their needs every day.
JD Hickey, M.D.
President and CEO
Marty G. Dickens
Chairman of the Board
Leading on Health Equity with Research Partnership
Throughout the COVID-19 pandemic, we’ve learned of its disproportionate effects on minority communities – and it has also shed light on other health disparities among Tennesseans.
To better understand the drivers of these disparities, the BlueCross BlueShield of Tennessee Foundation awarded $325,000 to Meharry Medical College’s Center for the Study of Social Determinants of Health. The grant funds research on barriers to health care, poor health outcomes and vaccine hesitancy in at-risk, largely minority communities.
Meharry researchers are using our Social Vulnerability Index (a tool that identifies factors that increase risk for negative health outcomes) to develop strategies to improve health equity and COVID-19 vaccine acceptance.
Expanding Specialty Pharmacy Savings
Specialty medications are often life-changing or life-saving drugs that treat serious, chronic conditions. By use, they’re a small percentage of annual pharmacy claims – but they account for a much larger share of overall pharmacy costs because they’re often cutting edge and require exacting administration by a provider. In 2020, we introduced a specialty pharmacy network to create savings for these drugs. Since implementing the program with self-insured customers, it’s resulted in $16 million in member savings. And for 2022, as we introduce the program to fully insured customers, even more members will have access to savings while continuing to receive the same medications, at their same trusted providers.
Earning High Quality Ratings for Member Care
In 2021, our Medicare Advantage PPO plan performed exceptionally well for members – earning our first-ever 4.5-Star quality rating from CMS. This industry rating is updated every year and considers up to 40 different performance measures, meaning the bar is continually raised in pursuit of improving member care. The PPO earned the highest possible rating on almost every measure, including efforts such as chronic condition management, timely screenings and treatments, and member satisfaction.
Our commercial plans also earned 4-star recognition from the National Committee for Quality Assurance (NCQA) – the only commercial plan in the state of Tennessee with this rating.
Pursuing Value-Based Oncology Care
To help members navigate the physically and emotionally difficult journey of cancer care, BlueCross and Tennessee Oncology have launched a value-based cancer care initiative. The program was modeled on other similar, highly effective programs, including the Oncology Care Model overseen by the Centers for Medicare and Medicaid Innovation.
The prevalence and cost of cancer care are primary drivers of this initiative: Roughly 18,000 BlueCross members undergo chemotherapy every year, with average claims of $75,000 for six months of treatment.
Our initiative follows BlueCross members at all phases of the cancer journey, from diagnosis through treatment and follow-up, and providers earn financial incentives or penalties based on how well members’ care is coordinated and documented. This model helps enforce proper care planning and treatment, and it ensures that physicians provide patient-centered care throughout the process.
BlueCross Medical Centers Offer Whole-Person Care
There are now eight BlueCross Medical Centers operating in Middle and West Tennessee, solely dedicated to serving BlueCross members and offering access to high-quality care. Our BlueCross Medical Centers, operated by Sanitas, are conveniently located, with expanded hours, online booking, telehealth options and online portals for viewing test results and messaging with doctors.
Throughout 2021, physicians and clinicians have been building relationships with patients, addressing acute needs while also exploring comprehensive, coordinated care with other in-network providers.
This proactive, patient-centered model helps individuals stay on their medications, manage pre-existing conditions, and avoid unnecessary hospital and emergency department visits – resulting in lower health care costs.
BlueSky Tennessee Institute Prepares Students for Tech Careers at BlueCross
Tennessee has roughly 4,100 technology job postings per year and only 1,000 qualified graduates to fill them. And as the work of serving BlueCross members has become increasingly technology-driven, we’ve committed to helping prepare more people in our own communities for these rewarding career paths.
In partnership with ETSU, we’ve developed and launched the BlueSky Institute. It’s an accelerated program that will give Tennessee students the opportunity to earn a bachelor’s degree in computing and a job offer at BlueCross – all in just two years. The program will help develop much-needed technology talent for BlueCross and prepare the next generation of technology leaders. So far, 32 students have been accepted into the program. They’ll complete their coursework at our Chattanooga BlueCross campus – becoming part of our diverse and inclusive workforce throughout their study and beyond.
Building Vibrant Communities Through BlueCross Healthy Places
Physical activity is one of the best ways to maintain and improve overall health – and bring people together. Since 2017, BlueCross has opened 11 BlueCross Healthy Places in all corners of the state, with more underway. They represent nearly $32 million invested in the health and wellness of our fellow Tennesseans.
BlueCross Healthy Places are purpose-built to maximize the impact on the communities they serve. Many BlueCross Healthy Places feature inclusive, accessible play areas for those with special needs – sending the message that individuals all of abilities and ages can come together for meaningful, developmentally appropriate recreation.
Empowering Tennessee Nonprofits to Improve Health and Wellness
The BlueCross Community Trust, established in 1999, provides support to non-profit partners across Tennessee. Funding focuses on charitable clinics, disease prevention and treatment, youth development, and diversity and inclusion.
In total, the trust donated $517,054 to Tennessee nonprofits in 2021. Our partner organizations work with underserved communities to provide a broad range of health and wellness support, such as:
- Helping children and families affected by HIV
- Providing mental health services, such as suicide prevention, to Tennessee youth
- Offering free or low-cost dental care to those in need – helping identify and prevent more serious conditions
Enhancing a Culture of Diversity and Inclusion
In a year of significant challenges including a global pandemic and a renewed national dialogue on racial injustice, BlueCross heightened its focus on fostering a workplace culture built on respect and trust.
In addition to making the Forbes Best Employers for Diversity list every year since its inception, BlueCross was recently acknowledged by the Human Rights Campaign as a Best Place to Work for LGBTQ Equality for a third consecutive year.
And we’re working toward creating a future that continues to chip away at lack of opportunity and underrepresentation of minority populations in health care: Our Power of We Scholarship program aims to create a more inclusive health care workforce by awarding six $10,000 scholarships annually to students intending to enter the medical field.