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Health Plan Performance
Healthcare Effectiveness Data Information Set (HEDIS®)
HEDIS is a set of standardized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA) which are the most widely used set of health care performance measures in the United States. These measures specify how organizations collect, audit and report performance information across the most pressing clinical areas, as well as dimensions of patient satisfaction and experience.
HEDIS is updated annually and consists of five domains of care. HEDIS allows for standardized measurement, reporting and accurate, objective side-by-side comparisons. The health plan uses its HEDIS results to continually improve the quality of care for its members.
If you'd like to learn more about HEDIS, visit NCQA's website.
Quality Assurance Reporting Requirements (QARR)
The New York State Department of Health collects health care data through an annual reporting system called Quality Assurance Reporting Requirements, or QARR. QARR measures are largely adopted from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data Information Set (HEDIS), with specific measures added to address public health issues of particular importance in New York.QARR is used to determine health plan performance on the areas of provider network, access and utilization, child and adolescent health, women's health, adult health, behavioral health and satisfaction with care.
To learn more about QARR, follow this link to visit the NYS DOH website.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
CAHPS is a program administered by the Agency for Healthcare Research and Quality (AHRQ), the lead federal agency involved in developing and distributing standardized, evidence-based surveys and related tools used to assess patient experience with the United States health care system (AHRQ CAHPS Program Brief). There are many different CAHPS surveys for ambulatory care and facilities. The health plan contracts with a certified vendor to administer the CAHPS health plan survey.
The CAHPS survey gives health plan members the opportunity to report on and evaluate their health plan and tell us about their experiences with their health care. Survey topics include access to care, test preauthorization, communication with doctors and health care providers, accurate claims and service received from customer care. There are commercial, Medicaid and Medicare versions of CAHPS.Survey results are used for National Committee for Quality Assurance (NCQA) accreditation and by other regulators.
Practitioner Performance
  • Partnering to Achieve Quality (PAQ) - Physician Quality Improvement Programs
    PAQ programs facilitate improvement in practice-based preventive health and chronic disease care. Programs are designed to bring systematic process changes in practices to improve the quality and affordability of care. The programs are primarily targeted at primary care practices at the individual practice level or within multi-practice organizations or groups.
  • Practice Management Resource Solutions (PMRS) Program
    The PMRS program combines many proven delivery strategies that are customized to meet the needs of the practitioner. PPI nurse consultants work with our clients, helping them assess and understand their operational issues; develop customized strategies for change; define measurable outcomes; and establish processes to sustain these improvements. Elements from different categories can be combined to create a program unique to the learning needs of the practice. Some category topics are:
    • Readiness Assessment
    • Practice Redesign
    • Patient Management
    • QI and Measurement/Model for Improvement
    • Certification Programs
    More information along with helpful tools and resources can be found in Practice Design Resources.
Hospital Performance
There are a number of tools available to members. Members are encouraged to use such information in conjunction with discussions with health care professionals.
  • Hospital Quality Improvement Program
    Through the Hospital Quality Improvement Program (HQIP), Excellus BlueCross BlueShield brings its network providers performance improvement tools to drive overall quality and cost improvement.
    Helping achieve gains in efficiency and effectiveness fosters significant collaboration and assists in controlling the cost of health care in our communities.
    Excellus BCBS is committed to strengthening the network’s providers. We have a dedicated Performance Improvement Department that works to identify ways in which collaboration can help improve provider performance and increase accountability for the quality and affordability of care.
    HQIP Programs Include:
    • Upstate New York Hospital Quality Initiative (UNYHQI) - Brings hospitals a technology-based service that works to reduce the incidence of hospital-acquired infections and produces measurable cost savings. This service is provided by Carefusion's MedMined™ services. * Fall of 2009 small/rural network hospitals were invited to participate in the UNYHQI Collaborative as non-automated hospitals. Follow this link to view more information on the Upstate New York Hospital Quality Initiative (PDF).
    • Upstate New York Surgical Quality Initiative (UNYSQI) - Brings hospitals the American College of Surgeons' National Surgical Quality Improvement Project, which is a nationally validated, risk-adjusted, outcomes-based program that measures and improves the quality of surgical care to improve surgical outcomes and reduce costs associated with them.
    • Critical Access Hospital (CAH) Performance Improvement Project - In an effort to reinforce and support the CAHs quality and performance improvement efforts the Health Plan is providing initiative participants with access to Performance Management Institute's EDManage+. This is an operational performance improvement tool for Emergency Department care.
    Excellus BlueCross BlueShield recognizes hospitals that have stepped forward to participate in our Hospital Quality Improvement Programs as a result of their ongoing commitment to quality health care!
  • Tools We Provide:
    • Click and Compare Care
      (Available to plan members only, requires login)
      Using this tool members can create a customized report to compare hospital performance and cost for more than 175 procedures and medical conditions at hospitals nationwide. The reports show the number of patients treated at each hospital, the percentage who developed problems, the percentage who died, the average length of stay, and the average price charged by the hospital. These reports are based on information hospitals provide to Medicare and their state's health departments or other local agencies.
  • Tools from Other Organizations
    There are other online hospital comparison tools available to the public. They include:
Contact Us
For more information or for requests for support, please contact the Provider Performance Improvement & Analytics Team. A nurse consultant will contact you to discuss resources available to support your practice's quality improvement activities.
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