BCBSA Shares Claims Data for Personalized Treatment Plans for MS

October 17, 2019 - Blue Cross Blue Shield Association (BCBSA) shares reports on claims data via the Health of America platform in the hopes that the information might lead to better personalized treatment plans.

The number 520,000 caught the attention of Vincent Nelson, MD, vice president of medical affairs in the Office of Clinical Affairs at BCBSA, and his team as they were analyzing multiple sclerosis (MS) claims data. Over 520,000 Americans covered by commercial insurance were living with MS in 2017, Nelson and his team stated in their The Health Impact of Multiple Sclerosis report.

“First we looked into the prevalence rate, and from our learnings believed it was worthwhile to do a full report so we could share this information with the American public so they can better understand how MS is impacting overall health,” Nelson explained in a written statement to HealthPayerIntelligence.com. “With more than half a million people living with multiple sclerosis (MS), it is crucial to better understand the impact of this condition on the health, wellness and quality of life of Americans.”

Nelson’s team narrowed down the pool of BCBSA claims to MS patients by using the MS diagnosis code ICD-9 (340). From there, the researchers studied not only the national presence of MS, but also the characteristics and common health experiences of MS patients.

No one knows the cause of MS or its cure, meaning once an individual has MS, they have it for life. By degrading the patient’s central nervous system slowly, disrupting the neurological signals in a different way for each body, the disease robs patients of 14.8 years of healthy life with physical and cognitive damage.

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“Multiple sclerosis is a complex and rare condition, so it affects each patient uniquely,” Nelson said.

While it may be rare, affecting only 24 in 10,000 members, it is on the rise at a quickening pace. The study found that the MS diagnosis rate grew by four percent over the course of three years, with a total of 21,700 new diagnoses between 2014 and 2017. Among those affected, 75 percent were women who were, on average, around 47 years old.

Often, members with MS also experienced other chronic conditions, which may multiply as the member ages.

Half of the members with MS suffered musculoskeletal comorbidities, weakness, or limited range of motion. Their rate of chronic health conditions, like hypertension or high cholesterol, was two to three times the national rate. The study found that about 40 out of every 100 persons with MS experience hypertension and around 38 out of every 100 persons have high cholesterol.

The comorbidities are not limited to physical conditions. Members with MS experience behavioral health conditions at three times the national rate.

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Over thirteen people in 100 who have MS also suffers from major depression. Three times as many members with MS have a substance use disorder compared to the rest of the nation, with 4.4 members in 100 battling disordered use of substances like opioids.

“While conditions like substance use and major depression can affect anyone, we cannot ignore the connection the report found that about half of those with MS are battling at least one other chronic health condition,” Nelson acknowledged.

“We believe it’s imperative for health insurers to monitor these connections to ensure members are receiving the appropriate care for different conditions when they need it.”

Payers should focus on personalized care for their members with MS, Nelson emphasized, specifically through precision medicine.

“The future of medicine for patients with conditions like MS lies in precision medicine, or tailoring treatment based on genetic makeup, environment and behavior,” Nelson asserted.

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BCBSA is not the first to suggest this approach. Aetna has been using precision medicine to predict breast and ovarian cancer. The payer developed over 50,000 genetic tests to identify 10,000 genetics-based conditions so that providers can execute preventive measures.

Providers lack the information to make these decisions on their own, which is the basis for BCBSA’s Health of America report series.

Payers can support providers’ ability to make the right diagnoses and treatment decisions by enabling them to see the genetic, environmental, and behavioral factors, Nelson said.

This personalized approach can be effective in both chronic disease management and prevention.

One Blue Cross and Blue Shield company, Blue Shield California, uses a combination of digital and physical platforms so that members can personalize their wellness approach.

In the digital platform, Wellvolution, members set personal health goals and are connected to a third-party organization. From then on, members can pursue their personalized health approach on their schedule with 24/7 assistance, lowering their risk of chronic diseases and managing conditions like MS or even reversing their type 2 diabetes.

In addition to personalizing treatment, Nelson pointed out two non-medical MS challenges that healthcare payers can help members face.

“People living with multiple sclerosis face numerous daily challenges, among them are accessibility and cost of care,” Nelson explained. “For patients in areas where specialty care isn’t easily accessible, we believe health insurers should develop programs to better coordinate care among both physicians and family members or friends who may be providing care for the patient at home.”

Part of supporting members in their day-to-day challenges is empowering the individuals who take care of them. Payers must remember that the effects of MS are not limited to the member who has MS but extend help to their caregivers as well, Nelson added. By educating caregivers and helping them provide coordinated care, payers can ensure lower costs and higher quality care for their members.

Keeping members with MS out of the hospital can critically tamp down healthcare spending. A separate study showed that hospital-administered medication can translate into thousands in unnecessary spending. For MS specifically, administering medications at home instead of in an inpatient setting could save members and caregivers $37,000 over the course of four months.

“Home caregivers are part of the overall care team and should learn about the disease, develop a plan for their loved one’s flare-ups and understand when to contact medical professionals,” said Nelson. “These efforts to coordinate care allow patients to live happier and healthier by staying out of the hospital and receiving care at home, thus keeping costs like co-pays down.”

By sharing the results of their claims data, BCBSA demonstrates the power of information in providing effective, affordable, coordinated care.