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Regence Applauded for Strategic Efforts in Customer Service, Consumer Transparency, Fraud, Care Quality Improvement and Cost Containment


PORTLAND, Ore., Oct. 11, 2012 /PRNewswire/ -- Regence was recognized this month by the Blue Cross and Blue Shield Association for leadership and best practices in consumer initiatives, customer service, fraud investigation and improving clinical care.

"This broad spectrum of achievement is recognition of the Regence health plans' influence nationwide as a leader in improving service and outcomes while curbing costs," said Jared Short, President Regence Health Insurance Services. "I applaud the teams that have made this achievement possible, and have worked to share our experience for the benefit of Blue customers nationwide."

The Best of Blue awards are:

  • 2012 Best of Blue  First Call Resolution
    Regence competed against 39 other Blue Plans in this category, which measured not only traditional customer service call-in metrics, but also included scores based on listening and understanding customer concerns to effectively connect them with the appropriate resources to help.

  • 2012 Best of Blue Clinical Distinction: Intensive Outpatient Care Program
    Patients with multiple chronic and complex medical conditions make up 60 to 85 percent of our nation's health care spending each year. To better address the needs of these members, the Intensive Outpatient Care Program (IOCP) was developed with providers and employers through a pilot program in the Puget Sound. As a result of the pilot, Regence expanded IOCP more broadly throughout the Regence health plans' service areas, has helped shepherd sister Blue Cross Blue Shield plans throughout the country and has advocated for the national spread of the program.
  • 2012 Best of Blue: Criminal Investigation
    Regence is dedicated to preventing fraud and abuse for its members and in the health care field. The company has a team of skilled investigators and data analysts that initiate investigations and respond to fraud and abuse schemes that crop up daily. Regence received a Best of Blue award for a recent criminal investigation that highlighted the innovative thinking and collaboration its special investigation unit (SIU) brings to this specialized field.

Regence customer service teams earned the award by enhancing the call-in system to ensure they identified the root causes of members' concerns, and mitigated any identified issues immediately, using new technology that changed the way information was disseminated to front-line call center staff. The result was 82 percent of calls resolved at the first contact — the highest among Blue plans nationally.

The program supports a Registered Nurse Care Manager employed by clinics to care exclusively for IOCP enrollees, offering 24/7 access to email, telephone and in-person visits. Primary care physicians enroll qualifying Regence members into the program. Regence provides participating clinics with the training and support they need to effectively manage the care for these members and ensure each member is progressing in self management, confidence, and taking steps toward their health goals.

As a result of Regence's success improving patient outcomes and reducing need for acute care, several Blue Cross Blue Shield plans and other organizations outside of Regence are integrating the IOCP model.

The specific case involved a fraudulent narcotic prescription ring using protected health information (PHI), stolen from an eye clinic, to obtain prescription drugs illegally in Oregon and Washington.   

The SIU conducted an investigation internally using data analytics, and collaborated with local and national enforcement agencies, including the Health and Human Services Office of the Inspector General, the FBI, and the U.S. Attorney's Office in Seattle. The outcome was jail terms for the individuals involved, and protection for members' premiums and medical records.

Since 2008, Brodie Dychinco has led teams at Regence to develop transparency tools that are now used by more than 10 Blue plans covering millions of members across the country. His contributions in setting a national transparency standard and roadmap for the Blues, and supporting their implementation of Regence's transparency tools, earned him the honor of being only the 12th recipient of the Guffey award, which recognizes one individual among the 39 Blue plans for leadership excellence and advancing health care transformation.

Regence's unique transparency approach and solutions were also recognized earlier this year by Forrester Research, Inc. (Case Study: Regence Cracks the Transparency Code, Forrester Research Inc., April 12, 2012)

About Regence affiliated companies
The Regence affiliated companies serve more than two million members through Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (selected counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. The Regence affiliated companies are committed to improving the health of its members and communities and to transforming the health care system. For more information, please visit or follow us on Twitter.

SOURCE Regence