Quality Program | Blue Cross MN

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

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:

Member Annual Notice

Your Member Annual Notice includes important information about your health plan coverage.

See 2024 Member Annual Notice

1. 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.

2. 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.

3. Eliminate health inequities in health outcomes. We do this by building an enterprise culture that values equity and inclusion and addresses the root causes of health disparities.

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

Lessons learned

To understand member barriers and supporters to accessing preventive care, we completed preventive care and community research in 2023. We learned many things, including:

Consumer panels highlighted the following important learnings regarding outreach and connection to members:
- Create personalized communication for member outreach
- Complete outreach in the preferred mode for the member
- Allow opting in to communication
Barriers to addressing preventive care include:
- Ensure that communication includes the value and positive aspects of preventive care
- Highlight and emphasize the benefits of preventive care and emphasize the importance of connecting with a primary care provider

2023 focus areas

More information on a few specific projects we worked on in 2023 is below. Each project has information on what was done and whether the project will continue in 2024.

Increasing awareness of preventive care

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.

What we’ve done

To address health literacy, Blue Cross has focused on providing education to members through text message, posts on social media platforms (e.g., Instagram), and electronic mail (email) on different preventive care topics like immunizations, cancer screenings and diabetes care.
To address racial disparities, Blue Cross engaged with a community organization to decrease the high rate of breast cancer deaths in African American women. A targeted messaging campaign to increase screening rates was created and tested in 2023.

Outcome

Blue Cross’ overall goal is to increase the percentage of members who receive annual preventive care screenings based on individual member needs. We are seeing improvements in some preventive screening measures but there is more work to be done. In 2023, a custom email was created and sent to Black women with an open gap in their breast cancer screening. This was created to address the healthcare disparities in screening rates for Black women compared to overall rate. The effectiveness of this email will be evaluated and considered for continuation or adjustment in 2024.

This project will continue in 2024. Additional mailings and information on preventive screening topics will be sent out throughout the year. Blue Cross will continue to monitor its communication strategy each year and make changes as needed.

Reducing disparity in diabetes care

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.

What we’ve done

Holding educational sessions on topics including Working with Non-English Speakers with Diabetes, Implicit Bias and the Pursuit of Health Equity, and Food as Medicine.
Gathering data to better understand and support member needs.
Working closely with Care Coordinators to close gaps in care for members.
Targeted education with care coordinators, providers and members.

Outcome

We improved our rates for blood pressure control and yearly A1C testing in 2023. However, we still found differences based on race and language spoken. Blue Cross keeps looking for ways to both increase rates and reduce disparity gaps. We have a new initiative and interest in getting feedback through community engagement to know our members, with an emphasis on reducing disparity gaps in care.

This diabetes project concluded in 2023. Blue Cross will focus on continued training and education opportunities with members and providers and evaluating ways to improve diabetes that address social and environmental factors that affect vulnerable populations. The new project for 2024-2026 will focus on both diabetes and coexisting depression.

Improving birth outcomes

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.

What we've done

Work in 2023 centered on setting the stage for continued success in this project. This included building and strengthening relationships with community partners, offering educational sessions on pregnancy related topics and increased member utilization of doula services.

Here are some additional actions taken in 2023:

Providing scholarships to support culturally compatible doulas
Outreach to community organizations and State agencies
Improving internal data processes and reporting
Releasing a social media campaign on immunizations in several languages
Offering incentives to members who complete annual wellness visits and get immunizations on time

Outcome

Blue Cross saw improvement in both prenatal and postpartum visit rates, however like most of Minnesota, our childhood visit rates for the first 15 months and immunization rates declined. We continue to see disparity gaps and will focus on how we can help all members improve timeliness of pregnancy care, well child visits and immunization rates.

This project continues in 2024 and plans to run through 2026, with ongoing discovery and improvement.

Member Annual Notice

Your Member Annual Notice includes important information about your health plan coverage. A summary of the topics included is listed below.

See 2024 Member Annual Notice

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

Accreditation

We take our accreditation by the National Committee for Quality Assurance (NCQA) seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Learn more about NCQA accreditation

Note: Programs vary depending on your health plan.

1 https://www.health.state.mn.us/communities/equity/ehdi/priority.html#diabetes