Quality Program
Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) is always working to improve the quality of healthcare and services our members receive.
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.
Overview
How we do it
We study several areas that impact our members and their ability to receive the medical and behavioral healthcare and services they need. A summary of these is below:
Member access to network providers
- Geographic distribution
- Appointment wait times
- After-hours care
Continuity and coordination of care
- Between providers
- Between settings
- Transitions of care
Oversight
- Delegates and vendors
Member feedback
- Complaints and grievances
- Appeals and reconsiderations
- Surveys
- Customer service inquiries
- Focus groups / Advisory boards
Population health management
- Managing complex conditions
- Disease management
- Health and wellness coaching
Network provider feedback
- Experience with health plan processes
- Patient safety standards and processes
- Utilization of services
- Acquired conditions and complications
Quality Program and evaluation
One way we work to improve quality is by measuring how well we and others (like your doctor or therapist) are doing. We review our programs every year to make sure we're continually improving.
We are guided by the following goals:
Improve health
Improve the health of our members and communities across the continuum of care. We do this by removing barriers to preventive and chronic condition care, improving social factors that affect health and decreasing the total cost of care.
Enhance the experience
Enhance the experience of our members by making their journey easy and understandable. We do this by intentionally designing a member journey that simplifies healthcare and empowers our members to make informed decisions.
Eliminate gaps
Eliminate gaps in health outcomes across all communities. We do this by building a respectful enterprise culture that values and reflects the many communities we serve, focused on addressing the root causes of differing health outcomes across various populations.
Resources
Member Annual Notice
Your Member Annual Notice includes important information about your health plan coverage. A summary of the topics included is listed below.
- Access to medical services
- Benefit booklet and summary of benefits and coverage
- Prescription and medical drug coverage and formularies
- Prior authorizations and benefit limitations
- Member rights and responsibilities
- Requests for an independent review of an appeal
- Use and disclosure of protected health information
- Care management programs
Note: Programs vary depending on your health plan.