Quality Program

What is a Quality Program?

A Quality Program monitors and evaluates care and services members receive. Blue Cross maintains a program that looks at the quality of access to and availability of care and services. We review data to help us identify areas we can improve, and we use this information to create a strategy to address gaps.

Each year we examine the program to see how we did. This gives us an opportunity to see where we are doing well or where we may need to make changes. Keep reading to find out more about our program.

Quality Program overview

The United States Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions.” Studies have shown that patients with limited literacy skills have less health-related knowledge, receive less preventive care, have poorer control of their chronic illnesses and are hospitalized more frequently than other patients.

Diabetes is a long-lasting disease that affects how your body turns food into energy. Diabetes isn’t yet a curable disease, but it is treatable and Type 2 diabetes can be prevented. Being physically active, eating a healthy diet and not using tobacco can greatly help prevent or manage diabetes. No matter how frightening and frustrating it can be, people with diabetes can live long, healthy and happy lives.

According to the Minnesota Department of Health1, diabetes is the sixth leading cause of death in Minnesota. Diabetes is also the leading cause of blindness, kidney failure and lower-limb amputations. In Minnesota, glaring racial and ethnic disparities in diabetes exist that show in the disease’s frequency, complications, and death rates and preventive care rates for people who have diabetes.

Disparities happen when the health of a group of people is negatively affected by factors like how much money they make, their race or ethnicity or where they live. Racial and ethnic disparities in diabetes are made worse by things like poor access to diabetes medicines, supplies and preventive care. This includes a lack of culturally and linguistically appropriate diabetes education materials, support system and diverse or culturally competent healthcare providers.

Several managed care organizations in Minnesota formed a performance improvement collaborative to work together to promote improved diabetes care for Minnesota people with a focus on members who have Minnesota Senior Health Options (MSHO) and/or Minnesota Senior Care Plus (MSC+) insurance. This collaborative also does outreach to community and government resources to find opportunities for shared efforts.

At a national level, overall maternal morbidity and mortality rates have increased in recent decades. Black women are three to four times more likely to die from pregnancy related causes than white women. In Minnesota, these disparities hold true for people of color and are seen in other important birth outcome data like infant prematurity, low birth weights and infant mortality.

These disparities continue into childhood and are reflected in childhood immunization rates. Nationally, immunization rates are around 90 percent for many vaccines, but disparities remain with significantly less vaccination coverage for black children (65%) and children living below the federal poverty level (64.4%).

Several managed care organizations in Minnesota formed a performance improvement collaborative to work together to promote a “Healthy Start” for Minnesota children and pregnant people with a focus on members who have Prepaid Medical Assistance Program (PMAP) and/or MinnesotaCare (MNCare) insurance. The collaborative is working on increasing the accessibility of doula services, culturally compatible care, increasing prenatal and postpartum visits, childhood immunization and well child exam rates.