CHATTANOOGA, Tenn. - Recently published articles in three national medical journals highlight BlueCross BlueShield of Tennessee’s implementation of evidence-based medicine to benefit health care quality and control costs.

According to company co-authors, Rick Mathis, Ph.D., manager of medical policy, and Sharon Doyle, RN, clinical quality coordinator, evidence-based medicine is the application of scientific evidence and clinical experience used to determine the effectiveness of medical treatments.

“With rapid advances in medical technology and the explosion of health information, health care professionals can have a hard time determining if a particular treatment lives up to its claims,” Mathis said. “By using evidence-based guidelines, BlueCross can put the wealth of available health information into context to determine what is medically proven versus investigational.”

A recent example of a need for evidence-base guidelines can be found in the case of hormone replacement therapy (HRT). HRT was once thought to be effective for treating menopause symptoms and preventing heart disease; however, new studies show that HRT does not prevent heart disease and can actually increase the risk of breast cancer.

Mathis emphasizes that the quality of care received by patients is the foremost concern for BlueCross, but quality is about what is most appropriate, not just the most expensive.

“BlueCross and our members are obviously interested in paying for effective treatments as opposed to spending valuable health care dollars on procedures that aren’t scientifically proven to work,” Mathis said.

Critical to the success of the evidence-based process is the constant feedback and input received from the network of BlueCross providers.

“The blend of our providers’ clinical experience and our medical policy staff’s evidence-based research helps to assure the medical value of treatments for our members,” said Dr. Ken Patric, corporate medical director for BlueCross. “This continuing mix of evidence and experience should produce healthy outcomes, affordable care and satisfied patients.”

The recently published articles include “Evidence-based Medicine: Why it can be a Case Manager’s Best Resource,” CareManagement; “Getting Physician Input into Medical Policy Decision: Filling the Evidence Gap,” Healthplan; and “Staying Sharp: Keeping up with Advances in Medical Technology,” The Case Manager.

About BlueCross

BlueCross BlueShield of Tennessee's mission is to provide its customers and communities with peace of mind through affordable solutions for health and healing, life and living. Founded in 1945, the Chattanooga-based company is focused on reinventing the health plan for its 3 million members in Tennessee and across the country. Through its integrated health management approach, BlueCross provides patient-centric products and services that drive health improvement and positively impact health care quality and value. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company's website at www.bcbst.com.