Tufts Medicine and Blue Cross Blue Shield of Massachusetts Announce Collaboration To Expand Access to Care and Streamline Prior Authorization

Tufts Medicine and Blue Cross Blue Shield of Massachusetts Announce Collaboration To Expand Access to Care and Streamline Prior Authorization

Blue Cross Blue Shield of Massachusetts ("Blue Cross") and Tufts Medicine today announced a strategic collaboration designed to reshape how patients across Massachusetts access and experience care.

Rooted in a shared commitment to connecting patients with the right care at the right time, the initiative enhances a traditional payer-provider relationship to address what matters most: expanding access to primary and specialty care, improving affordability and reducing clinician administrative burden.

Simplifying prior authorization

A central example of this multi-faceted work is streamlining the prior authorization process. Tufts Medicine will use the Humata Health solution to more rapidly process prior authorizations for Blue Cross members for select imaging services, including MRIs, with plans to expand to additional services.

By transmitting required information in minutes rather than days, clinicians spend less time navigating prior authorization and more time caring for patients.

The Humata implementation is part of a broader collaboration supported by the Massachusetts Health Data Consortium (MHDC), which operates the New England Healthcare Exchange Network (NEHEN), a regional health information exchange infrastructure. Through NEHEN FHIR®, Blue Cross and Tufts Medicine aim to enable the more seamless exchange of clinical and administrative data needed to support member care, referrals and claims processing

Expanding access to affordable care

Another example of how this collaboration is tackling some of healthcare's biggest challenges is the introduction of an innovative healthcare option that will be offered to Blue Cross employees during its upcoming open enrollment. The newly-created Tufts Medicine Alliance Network (HMO) will be offered as part of employees' plan choices. Designed to deliver coordinated, affordable care, this option offers access to a select network of high-quality providers-including Tufts Medicine, Boston Children's Hospital and Dana-Farber Cancer Institute. Participating employees will benefit from next-day access to primary care, dedicated navigation support for individual member care needs, both digitally and through their dedicated care team, and the ability to see a Tufts Medicine specialist within 21 days.

Both organizations are working together to develop similar offerings for additional customers and patients in the future.

Driving systemic change

Reducing administrative burden through prior authorization automation and introducing a new HMO offering for Blue Cross employees is part of a broader collaboration spanning other areas of healthcare.
Additional work includes:

• Driving affordability through expanded payment models: Blue Cross and Tufts Medicine are working to design and implement next-generation value-based payment models that support high-quality care while lowering overall costs. This effort builds on Tufts Medicine's long-standing participation in Blue Cross' Alternative Quality Contract (AQC).
• Transforming how care is delivered: The organizations are developing approaches to provide patients with faster access to both in-person and virtual care across the Tufts Medicine Integrated Network, including primary and specialty care. These efforts include expanding primary care capacity, integrating mental health services, enhancing after-hours urgent care access within the care team and improving turnaround time to specialty and ancillary referrals. The goal is to translate these new clinical approaches into improved access and experience for the members and patients each organization serves.

As part of this collaboration, Blue Cross and Tufts Medicine are investing in innovative solutions-such as technology, data analytics and other capabilities-that address the administrative and access challenges facing both organizations.

What they're saying:

• Sarah Iselin, Blue Cross' president and CEO: "Our two organizations share a mutual commitment to improving how healthcare works. It's going to take bold action to make it more affordable, easier to navigate and fundamentally less frustrating for individuals and families seeking care and for providers navigating administrative processes. This is the critical work ahead, and I'm excited to work with Tufts Medicine to build a better system together."
• Phil Okala, Tufts Medicine's acting president and CEO: "For too long, clinicians have spent enormous time and energy navigating administrative processes. This collaboration gives us a real path to change that-reducing friction in how we operate so our teams can focus on what they do best: providing a world-class experience for the patients we serve. The trust we've built with Blue Cross makes that kind of meaningful, lasting change possible."
• Jeremy Friese, MD, founder and CEO of Humata Health: "We are proud to work with Blue Cross Blue Shield of Massachusetts and Tufts Medicine to remove friction from the prior authorization process. That's why Humata Health was founded. Less friction and faster decisions mean patients get the care they need sooner, and physicians spend more time with patients than paperwork."