The Blue Cross Blue Shield Association created a unique number for its members to boost patient matching and interoperability across its network.
The Blue Cross Blue Shield Association (BCBSA) developed a patient matching algorithm for the payer community with an impressive 99.5 percent accuracy rate, according to a case study published in The Sequoia Project’s Person Matching for Greater Interoperability.
In 2019, BCBSA utilized its in-house data to build an algorithm and matching solution, called Master Member Index Identifier (MMI), to match member records and boost interoperability across its network. Over the past year, BCBSA identified over 93.5 million individuals spanning over 36 companies through this algorithm.
With individuals changing jobs and insurance plans, payers face similar patient matching and interoperability challenges as the rest of the healthcare community. Patient matching is a crucial ingredient in achieving the ultimate interoperability goal.
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ing the initial trial, BCBSA realized email addresses and phone numbers could result in overmatching. For example, a mother may use her telephone number for her young child. Conducting a records search using that telephone number would produce at minimum two records as results. To reduce the likelihood of overmatching, BCBSA assigned a unique number to each member across the company.
“This number is returned to the individual company for future activities in the services phase of the project,” explained the case study authors. “It is through the use of this number that companies request data from previous company membership across the system. This number is currently an internal data element that is not consumer facing.”
That 99.5 percent accuracy rate has set a pretty high bar for complete MMI onboarding. If a company matches less than 99.5 percent, it will have to resolve its matches until it hits the threshold. BCBSA then will monitor each company’s accuracy rate to maintain patient matching accuracy in the future.
Using a unique number instead of a Social Security number increases privacy and security. This is similar to the National Patient Identifier (NPI), a potential yet controversial patient matching option fix using a unique number assigned to US citizens across the healthcare system.
“The ability to match someone with their health data – regardless if they’ve changed insurers – is critical to ensuring people receive the care they need and deserve,” said Rich Cullen, vice president at BCBSA.
“To address this health industry need, we developed a way to safely and securely match a person’s health data from one Blue Cross and Blue Shield company to another. We believe this will lay the foundation for larger health data-sharing efforts within the broader health care system. We thank The Sequoia Project for their expertise and collaborative leadership, which is critical now as we continue to advance industry standards to make meaningful health information easily accessible.”
Looking forward, BCBSA aims to expand this project to all companies in its network.
While patient matching aids interoperability and patient data exchange, stakeholders must continue to develop additional ways to increase interoperability across the healthcare ecosystem.
“As the evolution toward seamless interoperability continues on its trajectory to provide information to authorized users, including (and especially to) consumers, when and where they need it, multiple facets of digital identity management must be considered as part of an integrated solution,” wrote the case study authors. “This need extends beyond the BCBS System and to the broader healthcare ecosystem.”
Source: EHR Intelligence