Independence Blue Cross, others to buy Massachusetts firm

Posted: February 14, 2012

Independence Blue Cross is joining with two other Blue Cross health insurers and a St. Louis software company to buy a Massachusetts firm that has what the buyers called the nation's largest real-time communication network for physicians, hospitals, and health insurers.

The price for NaviNet Inc. of Boston in the deal scheduled to be announced Tuesday was not disclosed, but Independence Blue Cross executives said in interviews Monday the combined capabilities of NaviNet and Lumeris Corp., the St. Louis partner, would help ease the way to a more efficient health-care system.

The goal is to "break down the fragmented way we deliver care in this country. It will put us and the provider on the same pathway," said IBC president and chief executive Dan Hilferty.

IBC's other partners in the deal are Highmark Inc., the Pittsburgh Blue Cross-Blue Shield company whose plan to merge with IBC was withdrawn in 2009 after meeting with heavy regulatory resistance, and Horizon Blue Cross Blue Shield of New Jersey, that state's biggest health insurer.

The three insurance companies work with more than 70,000 physicians and hospitals and insure 11 million people.

IBC already had a stake in NaviNet, said Steve Udvarhelyi, the insurer's executive vice president of health services, who oversees information technology. The various ownership stakes of the buyers were not disclosed. The deal is expected to close in 30 days.

For more than a decade, doctors and other health-care providers in IBC's network have been using NaviNet, founded in 1998, to submit claims and handle other administrative functions, Udvarhelyi said. NaviNet handles 70 million transactions a year for IBC, he said.

The NaviNet network has been expanded, Udvarhelyi said, to include some clinical information about members, such as whether someone with high blood pressure has filled prescriptions, but the combination with Lumeris will expand the level of such information that can be provided to doctors.

The Lumeris platform integrates claim and clinical information about individuals and about a population of patients, such as all the diabetics being treated by a doctor's office, Udvarhelyi said.

The hope is that easier information access will reduce costs by eliminating redundancy, preventing exacerbations of chronic illnesses, and avoiding complications caused by conflicting treatments, he said.

Health-care reform envisions the establishment of so-called accountable care organizations to manage health care for large groups of people, with built-in incentives for low-cost and high-quality doctors and hospitals.

Information is key to making that work. IBC and the other insurers are betting that Lumeris and NaviNet can make it all click.

If the combination works, "hopefully, that will be an impetus for others, as well," to use the system, Udvarhelyi said.


Contact staff writer Harold Brubaker at 215-854-4651 or hbrubaker@phillynews.com.

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