BCBSNC - sporedata/researchdesigneR GitHub Wiki

• Blue Cross Blue Shield of North Carolina (Blue Cross NC) is the largest health insurer in North Carolina, covering more than four million lives as of 2020. With a significant market share, Blue Cross NC has led a statewide shift toward value-based care (VBC) through its innovative Blue Premier program. This initiative, launched in 2019, aims to align incentives for improving the quality of care and creating a data infrastructure for standardized reporting to support clinical improvements and manage the total cost of care. Blue Premier started with five initial health system partners and has since expanded to eight, reporting both quality improvements and cost savings.

• Blue Cross NC plays a significant role in the state's healthcare landscape, offering a broad range of insurance products and services to meet the needs of individuals, families, and businesses.

Blue Cross NC supports various research activities, including:

• Policy and Equity Advocacy: Promoting policies that ensure health equity and address social determinants of health.
• Health Systems Development: Improving the infrastructure and efficiency of health systems.
• Community Health Improvement: Addressing health disparities and promoting well-being at the community level.

• Data Misuse: There are significant worries about how shared data might be used improperly or without consent.
• Financial Concerns: Organizations fear that sharing data within the same market could lead to a loss of competitive edge.

• Common Data Points: Initiating data sharing with information that is common across all participants to facilitate smoother integration.
• Leadership Engagement: Involving high-level leadership such as Chief Medical Officers (CMO) and Chief Medical Information Officers (CMIO) to oversee and support the data-sharing process.
• Alignment with Strategic Goals: Ensuring that the objectives for data sharing align with the broader strategic goals of all contributing organizations.

• Technical and Operational Pilots: Testing the data-sharing processes with a partner who is not only motivated but also has the necessary resources to effectively address and overcome challenges that arise during implementation.

Blue Cross NC maintains a diverse range of health data, including:

• Demographic Data: Age, gender, race, ethnicity, socioeconomic status, education level, employment status, marital status, geographic location, and language preference.
• Health Indicators: Disease prevalence (e.g., diabetes, hypertension, asthma, cardiovascular diseases), health behaviors (e.g., smoking status, physical activity levels, dietary habits), health outcomes (e.g., mortality rates, hospitalization rates, readmission rates), vaccination status, and chronic disease management.
• Environmental Data: Air quality indices, exposure to pollutants, access to green spaces, neighborhood safety, housing conditions, proximity to healthcare facilities, and availability of recreational facilities.

• Data Preparation: Focuses on standardized datasets, which may limit custom data requests.
• Data Integration: Variability in data formats and standards can present integration challenges.
• Privacy Concerns: Ensures strict adherence to privacy regulations and data protection protocols.
• Access Restrictions: Data access is subject to compliance with regulatory and ethical standards.

• Sharing Health Data: The Why, the Will, and the Way Forward
• Use of big data by Blue Cross and Blue Shield of North Carolina
• Blue Cross Blue Shield North Carolina October 2017 Medical Policy Updates
• Blue Cross and Blue Shield of North Carolina encourages kids to "be active"
• Data warehouse governance: best practices at Blue Cross and Blue Shield of North Carolina
• The payer perspective: Blue Cross and Blue Shield of North Carolina's approach to the obesity epidemic
• Cost sharing and its effects on hospital utilization: The Blue Cross and Blue Shield of North Carolina experience. Medical Care.

Academic and research institutions can access Blue Cross NC datasets by submitting a research proposal and undergoing the necessary compliance and review processes.

Researchers are required to submit an online application, including a detailed research proposal and conflict of interest disclosure. Access to data is granted upon approval by an independent review panel, ensuring responsible and ethical use of data.

[1] Grossmann C, Chua PS, Ahmed M, Greene SM. Sharing Health Data: The Why, the Will, and the Way Forward. 2023.

[2] Grossmann C, Chua PS, Ahmed M, Greene SM. CASE STUDY: Blue Cross Blue Shield of North Carolina. National Academies Press (US). 2022.