Improving Operational Efficiencies

The Blue companies recognize that interoperability and transparency between insurers, doctors, hospitals, businesses, policy makers and consumers are essential. By supplying more relevant, timely infor­mation to guide decision-making and facilitate action, a knowledge-driven healthcare system will help make the interactions between stakeholders more efficient and successful.

The BlueWorks^® winning programs featured in this section provide examples of creative uses of technology and processes for better data collection and management, resulting in the development of evidence-based treatment solutions and administrative efficiencies. This leads to safer, more efficient care, and improved customer service.

BlueWorks^® Anti-Fraud
An important component of the Blue commitment to improving operational efficiencies is our effort in combating healthcare fraud abuse. The BlueWorks Anti-Fraud Awards Program was introduced in 2005 and recognizes successful efforts by Blue Plans to protect consumers from healthcare fraud.

• Industry Collaboration to Simplify Office Administration (2005)
  Blue Cross Blue Shield of Massachusetts
  
  
• My Insurance Manager for Healthcare Professionals (2005)
  Blue Cross and Blue Shield of South Carolina
  
  
• Advanced Access (2005)
  Blue Shield of California
  
  
• Secure Online Communication Helps Providers and Patients (2004)
  Blue Shield of California
  
  
• Preventive Health Reminder Call Initiative (2004)
  Horizon Blue Cross Blue Shield of New Jersey
  
  
• Provider Information Site (2005)
  Regence BlueCross BlueShield Oregon
  
  
• Community Health: A Health Plans' Contribution (2006)
  
  
• Promoting Hopsital Patient Safety (2006)
  
  
• Fraud and Abuse Wellness Training (2005)
  Anthem Blue Cross and Blue Shield
  
  
• Thomas E. Hoshour D.O./Sober Life Alternatives (2006)
  Anthem Blue Cross and Blue Shield



• Massachusetts Amnesty Program (2005)
  Blue Cross  Blue Shield of Massachusetts
  
  
• Controlling Small Group Eligibility Fraud (2006)
  CareFirst BlueCross BlueShield
  
  
• Refocused Initiative on Fraud and Abuse (2005)
  Independence Blue Cross
  
  
• A Little Birdie Told Me (2005)
  Independence Blue Cross