[Case Study] Premera Blue Cross Combines Claims and Clinical Data to Improve Care and Business Performance


Health plans have long operated using only retrospective claims data for making business and care decisions. But with the ongoing transition from fee-for-service to value-based care, claims data is no longer sufficient. Forward looking health plans need a near real-time view into the health and care of their members, and into their own performance.

This case study outlines how Premera Blue Cross innovative, efficient, and cost-effective solution has overcome this challenge, and how they are now able to:

  • Properly code high-risk members’ conditions for appropriate reimbursements
  • Provide real-time insight into members’ care and share it with providers 
  • Create a richer care experience by closing gaps in care 


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