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Blue Cross of Idaho's Cost Containment Programs

Pharmacy Management

Blue Cross of Idaho provides fully integrated pharmacy and medical benefits. We get the best prices for pharmaceuticals through volumepurchasing and encouraging the use of generic drugs, and Web-based tools for cost comparisons and benefit self-management. Blue Cross of Idaho’s pharmacy management efforts currently save approximately $75 million per year. In 2009, network discounts, volumedriven rebates and promoting generic drugs saved members an average of $29 per prescription.

Claims Management

Blue Cross of Idaho utilizes an automated claims processing system to handle tiered benefit designs. We also offer online customer self-service tools and employ dedicated appeals and grievance coordinators. Highly sophisticated software looks at every claim to ensure the services are grouped in the most appropriate manner. This process checks for “bundling” and “unbundling” of services and whether the provider used appropriate coding for the place the service was performed and the difficulty of the service. This process plus additional review and audit procedures saves our clients approximately $7.6 million per year.

Healthcare Intelligence

Our predictive modeling tools help us identify which employees need healthcare services to avoid complications and predict the costs of care based on the severity of illness. We also prepare Idaho customized data analysis and reporting based on your requirements. This includes claims summaries, member profiles, guideline compliance reports and cost savings analysis for care management and pharmaceutical requests. And we provide access to our Dynamic Reporting Tool, the internet-based point-and-click data analysis engine.

Case Management

Our Case Management Program assists people with highcost, or potential high-cost care scenarios to use services in the most cost-effective and appropriate manner. We also provide specialty case management in the areas of neonatal, high risk pregnancy, oncology, transplants and mental health and provide on-site case management at local NICUs to ensure proper care.

Prior Authorization

Prior authorization is the process of obtaining coverage approval for a medical service or procedure, other than in the case of an emergency. To learn more click here, or refer to your specific policy to find out which procedures and services require prior authorization.

Provider Network

At Blue Cross of Idaho, our provider network is just that—a system of health care professionals that you can connect with when you need medical care. It is a group of physicians, hospitals and other providers that we have contracted with to deliver savings to our members. To learn more about provider networks click here.

Disease Management Programs

The goal of disease management is to offer intervention and education. We encourage members to play an active role in managing their illness and include their doctors in the process.

Download a complete list of Disease Management Programs (740kb).

We also encourage you to take advantage of our Healthwise Knowledgebase that covers specifice conditions over here.

Wellness Support Tools

Our wellness tools include health and well-being assessments, targeted risk assessments and lifestyle management programs designed to support you in your efforts to improve and maintain your health. Members have access to a comprehensive user experience that allows members to:

  • Take any of the six personal health assessments, with personalized scores and reports to help improve lifestyle
  • Review all health related material on the site - covering everything from coping with back pain to making a healthy choice in a restaurant
  • Receive regular bi-weekly email communications
  • Access WellConnected anywhere in the world
  • All personal information is completely confidential

Resource Center

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