Excellus BlueCross BlueShield is committed to contributing to improving the quality of life in the communities we serve. To support this mission, we maintain a Quality Improvement Program designed to improve the clinical care and services we provide to our members, providers, practitioners, and others through active partnerships.
Our program's goal is to encourage the timely delivery of needed and effective care. We evaluate our success through measurably improving the health and satisfaction of everyone we serve, including enrollees, providers and others throughout our community.
Our Quality Management Program activities...
- Promote preventive health services and improve the health of members with acute and chronic conditions;
- Assess quality measures and implement targeted interventions to improve the overall health care of our members;
- Assess continuity and coordination of care across the range of treatment interventions and sites of care;
- Evaluate and improve behavioral health care and services;
- Evaluate the effectiveness of clinical care and services;
- Assure the credentialing and recredentialing of practitioners and providers;
- Evaluate the accessibility and availability of services to our members;
- Collaborate with community practitioners and providers to incorporate patient safety into health care;
- Evaluate and assess new technology that can benefit all we serve;
- Assure our members are satisfied with our Health Plan and our practitioner network;
- Assure our participating practitioners are satisfied with our Health Plan;
- Protect the confidentiality of our members, practitioners, and providers;
- Maintain compliance with accreditation and regulatory requirements.
The Major Goals of Our Quality Management Program Are to...
- Improve outcomes through the selection of issues where opportunities for improvement exist.
- Engage practitioners and providers to become more active quality improvement partners.
- Meet regulatory, accreditation and purchaser requirements.
- Improve service to enrollees and practitioners.
- Engage members to become more active and educated healthcare consumers.
Ways We Strive to Meet Our Goals...
- Support practitioner, provider, vendor, community, and enrollee efforts to achieve improved functional and clinical health outcomes using the chronic care model approach.
- Monitor the safety of care provided to enrollees in the inpatient and outpatient settings and
- Adopt and distribute practice guidelines for the delivery of preventive health, acute and chronic medical and/or behavioral health services that are relevant to the enrolled population.
- Implement interventions to reduce unwarranted variation within health care practice.
- Provide practitioners and hospitals with information on performance compared to standards and benchmarks.
- Assess enrollee access to providers and services and identify opportunities for improvement.
- Evaluate and report member satisfaction and identify improvement opportunities.
- Evaluate and report enrollee and practitioner satisfaction and identify improvement opportunities.
- Maintain a strategy to meet changing requirements of accreditation and regulatory agencies.
- Maintain systematic processes that provide sufficient evidence for accrediting bodies, regulatory agencies, and purchasers.
- Develop and implement processes to inform and educate enrollees that facilitate informed and collaborative decisions in their own care based on safety, quality, and cost of care.
- Assess racial and ethnic disparities in health care and develop processes and programs to reduce these disparities among enrollees and in the community.
- Integrate care management programs into physician office processes.
- Provide tools and incentives to encourage practitioner participation in and effective utilization of care management programs and health information technology.
- Develop integrated care management programs and provide tools and incentives to support active enrollee participation.
For more information regarding our Quality Management Program and our progress towards meeting the goals, please contact us at the number listed on the back of your identification card.