Data help physicians track patients, compliance

Provide ideas for better patient care

To get, on their own, the information that Pittsburgh-based Highmark Blue Cross Blue Shield’s SMART Registry provides them, physicians would have to conduct extensive and time-consuming chart reviews.

The reports provided by the Pittsburgh-based health plan give physicians feedback on the entire population and on specific patients with chronic conditions. They point out opportunities for better patient care, such as showing evidence from the claims that evidence-based practice guidelines for a specific chronic disease are not being met.

"We want to ensure that the physicians treat and test patients on a regular basis according to evidence-based practice guidelines," says Don Fischer, MD, MBA, a medical director for the insurer.

The registry has been refined on a regular basis since it was rolled out in spring 2002 for some practices in one plan. The entire network was included in July.

It includes five chronic conditions: asthma, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and diabetes, along with hypertension, which represents a significant comorbidity for most patients in the disease management programs.

A spreadsheet shows whether 13 quality indicators have been met for each patient. Patient information includes date of birth, age, gender, chronic diseases, and number of primary care visits during the past year.

The quality indicator data are color-coded. A claim for a quality indicator is green. Yellow means there is an opportunity to improve care.

"The physicians can look down the columns and easily see if there is one indicator they aren’t doing consistently well," Fischer says.

For instance, one significant problem among Highmark patients is the failure of diabetics to get eye examinations.

"Many patients don’t understand what needs to be done. They may not understand that it’s a medical benefit, rather than a vision benefit, and they may go to the wrong physician and get the wrong test," Fischer says.

The health plan is educating the physicians about the dilated retinal eye examination, and working with employers to promote the exam among their health plan members.