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Blue Shield dashboard: ACOs linked to lower inpatient costs but data gaps prompt investigation
Summary
Aon Hewitt presented a Blue Shield dashboard showing decreased inpatient days and a stable total cost per member attributed in part to ACO activity; the board asked staff and Blue Shield to investigate unexplained drops in lab and surgical reporting.
Aon Hewitt and HSS data staff presented a Blue Shield dashboard summarizing utilization and cost trends for active members in the Blue Shield HMO plan. Presenters said ACO enrollment comprises about 60% of the plan’s active membership and credited ACO initiatives with reducing inpatient costs and days while stabilizing overall cost per member.
Key findings presented: over a three-year window total cost per member per month rose about 0.9% year-over-year compared with industry trends of 8.5–10%; inpatient costs as a share of the premium fell (presenter cited a 12.7% reduction in inpatient service share); outpatient procedures increased, driven in part by colonoscopies; pharmacy cost per script decreased, aided by a 7% increase in generic dispensing; and the number of high-cost claimants fell by about 15.3%.
Data quality concerns: commissioners flagged a sharp decline in lab services and surgical procedures in some charts (one showed lab encounters falling markedly since January 2012). Presenters said the dashboard uses claims data and that the drop could reflect reporting lags associated with capitation, underreporting, or EMR/EPIC integration. HSS said it has opened an investigation with Blue Shield and will return with findings.
Member impacts and initiatives: Staff highlighted ACO interventions — e.g., a local nurse advice line and small urgent-care clinics intended to reduce ER utilization — and noted potential future savings to the trust fund from outpatient cost reductions (presenter estimated a $313 per-member change translating to about $1.4 million for the trust fund). The board asked for additional breakdowns (utilization vs. unit-cost drivers) and follow-up on lab and surgical reporting anomalies.
What’s next: HSS and Aon Hewitt will continue to analyze the dashboard, probe data anomalies with Blue Shield, and report back to the board with clarified utilization and cost-driver information.
Sources: Blue Shield dashboard presentation by Aon Hewitt and Q&A with HSS data analytics staff.
