Skip to menu Skip to content

Tag: Blog

30 Nov 2020
Melody Bautista, Director Clinical Data Analytics

Meet the Team – Case Management

From new product launches to partnerships with 2nd.MD and the National Hemophilia Foundation, there’s a lot going on in our Large Claim Solutions vertical. Director of Clinical Data Analytics, Melody Bautista, shares what she’s been working on, and is the perfect example that no two days are the same here at BCS!

Q: Describe your/your team’s role at BCS. 

A: I am the Director of Clinical Data Analytics and work mostly on BCS’s large claim solutions products and services.  My role/responsibility includes data analytics, clinical claims review, risk/cost management, and R&D. We are using an integrated data approach to bring together relevant clinical and claims data in a form that supports a variety of tools and analytics that we can leverage to improve outcomes, quality, and cost for our Blue Plan partners and payers. We identify high cost claimants (HiCCs) using predictive analytics tools and trigger reporting (diagnosis, specialty drugs, Gene Therapy/CAR-T) to identify members that are most likely to incur at least $250,000 in claims spend, then perform clinical claims review and identify BCS Risk Navigator solutions for our customers to contain costs and help their members achieve quality outcomes.

Q: What does a typical day look like for you at BCS?

A: Every day brings plenty of variety.  In a single work day I can work on press release and webinar content with marketing, on development of our HiCC database with Data and IT, conduct clinical claims review from trigger reporting, have meetings with our Blue Plan partners, review a specialty vendor Master Service Agreements with legal, work with account management and sales on an XOL Operations deliverables, assist coordination of SFTP set up with the Data and IT teams, work with our business analyst on clinical data analysis, research Specialty Pharmacies for a limited distribution drug, work on diversity and inclusion initiatives with our Culture Team, and work on process improvement activities with my Six Sigma team. Unlike Phil from Groundhog Day, I can honestly say that I have never had the same day twice and every day is an unknown adventure waiting to unfold.

Q: What trends are you watching in the healthcare industry right now?

A: There are many healthcare trends to watch right now from COVID-19 impact, to changes in healthcare delivery systems, and factors contributing to rising healthcare costs and premiums, but my main focus is always on HiCCs.  That includes paying attention to trends in million-dollar claims, emerging high cost therapies (Gene Therapies, CAR-T, immunotherapy cancer treatments) and specialty drugs, Stop Loss data trends, payment financing models (VBAs/OBAs), and more.  We use the knowledge of these healthcare trends and combine that with our claims/clinical data analytics information to develop highly relevant HiCC solutions to help our customers mitigate risks and improve outcomes.

For example, our actuary department provides us with an annual reports of the highest cost claims conditions and we combine that information with national healthcare information and our data analytics tools, predictive analytics outputs, and clinical claims review reports to identify what conditions we need to target for specialized solutions.  Out of that comprehensive data collection process and analysis, we determined we needed to find the best solutions to address members with oncology conditions like lymphoma and leukemia that persistently sits at the top of the highest cost conditions categories for the healthcare system nationally. That is why we partnered with 2nd.MD to provide top-tier medical navigation, expert consultation, and personalized second opinion services.  With this partnership, BCS can help members get the appropriate care they need, connecting them with board-certified, elite specialists from top medical institutions, and reducing their costs along the way.  In many cases, the second opinion can change the treatment trajectory – 85% of 2nd.MD’s consultations result in improved treatment plans, 35% lead to alternative diagnoses, and nearly 30% of surgery consults result in surgery cancellation.

Using this data, we developed two other customized solutions to support the approximately 20,000 individuals with hemophilia.  With the average annual cost for a patient with hemophilia topping $350,000 – $500,000 a year, we made it our priority to bring to market a solution set for health plans and their members to improve the quality and cost of care for members with hemophilia.  We partnered with the National Hemophilia Foundation (NHF), a trusted advocacy organization aligned with our focus on assisting with quality and cost of care. In addition, we also partnered with Audaire Health to provide hemophilia treatment management that improves patient adherence for high-cost therapies through real time tracking and pharmacy notifications.

We are looking to expand our customized specialty solutions to target more conditions, including Hereditary Angioedema/Defects in the Complement System, Cystic Fibrosis, Multiple Sclerosis, etc.  There is great interest and excitement for these customized solutions and we are currently working with our partners on implementation.  We are also excited to have recently joined our partners at the NHF, who are working on a collaborative with a mission to connect payers and patient advocacy groups to improve access to high quality care and address issues surrounding high-cost claimants through open dialog and shared solutions. I must say, I am truly proud to work for a company that strives to mitigate risks with cost containment solutions and improves quality of care outcomes for members.

Q: What are the most important skills you bring to your role?

A: The most important skills for this role are; flexibility/agility, a collaborative spirit, a strong interest in R&D/innovation, analysis, problem solving, and a having very curious mind.  Anyone who knows me knows how much I love solving puzzles and my keen interest in analysis is a great fit for this position because I enjoy recognizing patterns, looking for outliers or anomalies that help identify opportunities, and using data analytics to help guide better business decision making.  It also helps to be resilient and to view setbacks not as “failures” but as challenges or an opportunity for improvement.

Q: You have quite the commute. Pre-pandemic, what are your favorite ways to pass the travel time?

A: I have always had a long commute even when I used to live in the suburbs and took the train to the city but with this reverse commute, I actually use my commute time for prayer. Oddly enough, it is a good way to stay nice and calm during my long commute from the city. It’s tough to get upset with bad drivers when I’m thinking about the people in my life that I am grateful for.

26 Oct 2020
Susan Lindquist - Chief Human Resources Officer

Meet the Team – Human Resources

There’s perhaps no one better to offer insight into what it takes to succeed at BCS than Chief Human Resource Officer Susan Lindquist. This month, read on for insights from Susan – plus more about her role, her go-to resources for professional development, and the number one thing she’s sharing with employees about benefits enrollment.

Q: Describe your/your team’s role at BCS.

A: Our team’s role is to ensure we have the right talent available to meet our strategic goals.  To that end, we need to create a compelling employee experience that includes highly competitive rewards, opportunities to learn and grow, a vibrant workplace and strong personal connections within our BCS community.  We have almost 40% of our company engaged in culture-building activities including wellness, recognition, diversity and inclusion, community involvement and event planning.

Q: What do you like most about your job? What do you like least?

A: I enjoy the diverse responsibilities of my job.  I can be working on a strategic project in the morning, interviewing a potential new team member at lunch, and then finish my day by approving payroll.  I love that our small company size allows me to know all of our team members!  I least enjoy proofing Summary Plan Documents and Certificates of Insurance for our benefit plans.

Q: What skills does someone need to succeed at BCS?

A: In the last several months, we updated our company Beliefs to reflect both our values and our aspirations.  It’s very important that our current team members continue to embrace these beliefs and we hire new associates who commit to them:  diversity, transparency, simplicity, agility, integrity, and unity.  We can teach most skills!

Q: As we approach annual benefits enrollment, what is the number one thing you’d like to share with employees?

A: Make sure you use our wellness benefits!  Last year, we initiated a Lifestyle Spending Account which reimburses employees for up to $500 annually for expenses related to their wellbeing like gym membership, athletic equipment, financial planning and so much more.  Our Wellness Team also has created some great programs like virtual Cooking Conversations, 1:1 nutrition coaching and meditation.

Q: You are a big advocate for professional development. What are your go-to resources?

A: I am very proud that BCS prioritizes learning with such strategic importance that it is included in our Performance Scorecard.   I love the thought leadership that I find at Gartner and Center for Creative Leadership, and the quick wins I get from Harvard Business Review’s Management Tip of the Day and Daily Alert.  I also enjoy a good read and enjoyed sharing Mindset by Carol Dweck with a small book club last year at BCS.

28 Sep 2020
Christopher Halsey

Meet the Team – Service and Operations

This month, Chris Halsey, director, Service Partner Management (and resident “Top Gun” enthusiast), shares some of the projects he’s been working on, and how he’s adapted to virtual vendor and relationship management.

Q: Tell us about a project you are working on.   

A: I continue to work on refining our new administrative platform, and configuring it to support our EssentialCare products.  This includes creating and adding customer communication pieces, customizing the portal technology, and automating the information feeds to downstream systems.

I have really enjoyed working on this project as it allows me to work with many different areas and individuals in BCS.  It was a great honor to be entrusted with the responsibility of implementing this platform during my first year and a half at BCS.

Q: What is the number one skill someone in your role needs to succeed?

A: Negotiation skills.  I consider myself more of a “generalist” and need the support and knowledge of the experts in the different areas of BCS to help me.  Negotiation skills are critical when trying to convince someone to put aside their day job and help me with my project or initiative.

Q: What do you like most about your job?

A: Working with just about all areas in the company and multiple individuals.

Q: You work with vendors all over the country. What tips do you have for managing virtual partnerships?

A: Develop a sense of humor, of which I am still working on.  I always feel laughter is a good way to build partnerships, in the right moment. The key is knowing when it is the appropriate time.

Q: What’s your favorite way to relax? 

A: Ever since I started using my Fitbit, I enjoy walking and biking to see how many steps and miles I can accumulate in a day.  When not competing in my imaginary Olympics, I enjoy watching movies and several different streaming series.  And in case you did not know it, I’m a closet Top Gun fan!   Well, maybe an open-door closet that has an F14 flying out of it.

23 Sep 2020
Culture Badge from Enerage

BCS Earns 2020 Culture Badge from Energage

There has been much written about an organization’s culture – and what exactly that entails. Most thought leaders agree that a simple definition is “the way we get work done around here.” But of course, there’s more to a company’s culture than just how we do things.

At BCS, we understand that strategies, products, and services can be copied, but our culture is unique to us. At the core of our culture is letting employee voices be heard, and that’s why we regularly survey our team members and benchmark results against our industry’s Best in Class.

Based on our 2020 survey feedback – in which 90% of employees responded – BCS was awarded the “Clued In Employees” badge from Energage.

This badge means that BCS ranked in the top 25% of organizations when it comes to employees feeling “clued in” about what’s going on in the company. We are proud to be recognized with this distinction, especially now, while many of still work and receive company information virtually.

Corporate culture is an important aspect of life at BCS, and we thank all of our teammates who engage and work each and every day to be part of our culture.

17 Aug 2020
Meet the team - Nadia Nelson - Director Business Development

Meet the Team – Business Development

This month, we learn about Director of Business Development Nadia Nelson. A month into her new role, Nadia shares what brought her to BCS and how her past experience with Blue Cross Blue Shield will help move her – and BCS – forward.

Q: What do you like most about your job? 

A: I am only a month in but so far, I really like that I’ve able to work with so many different clients and partners. I’m a very social person, so, being able to interact with so many new people has been very exciting.

Q: What brought you to BCS? / Why BCS?

A: It was a great opportunity that presented itself to really grow in my career and expand my relationships within the Blues family. One of my good friends from my previous company joined the BCS team a few years ago and that helped with the move. To know that I would already have a friend at BCS, especially when starting during a global pandemic, made the transition a lot easier.

Q: Describe your department in three words.

A: Driven, supportive, hard-working.

Q: What have you been up to during the recent quarantine?

A: My husband and I recently bought a house and moved to the suburbs from the city. Once quarantine hit, I quickly went to work to get our back deck and yard up to par to enjoy some alfresco living.