Blue Cross and Blue Shield of Illinois (BCBSIL) offers members health management programs at no additional charge.

Asthma Project

Since this project was initiated, the Blue Cross and Blue Shield of Illinois HMOs rate of asthma hospitalization has decreased annually. To improve asthma care, we:

• Offer a personal asthma care kit at no additional charge to members with asthma
• Send an annual reminder urging members with asthma to get flu shots
• Distribute an asthma care diary to help members better manage their asthma care
• Survey a random sample of members with asthma to evaluate its impact on their daily lives and to assess whether their asthma medical care follows national guidelines, and then provide survey feedback to medical groups
• Provide asthma care guidelines to doctors and actively encourage them to give written self-management plans to their asthmatic patients
• Feature asthma care articles in member newsletters

Diabetes Project

To improve the care that diabetic members receive, the HMOs of Blue Cross and Blue Shield of Illinois:

• Adopted diabetes clinical practice guidelines and distributed them to all medical groups and primary care physicians
• Monitors compliance with the use of the guidelines, including the percentage of diabetic patients receiving eye examinations
• Actively encourages network physicians to use diabetes flowsheets to provide patient care in accordance with the diabetes guidelines
• Presents several workshops for both doctors and office personnel on diabetic care management
• Sends quarterly education materials on diabetes care to diabetic members

Coronary Artery Disease Program

In 2003, BCBSIL implemented pay-for-performance programs in which HMO medical groups/ IPAs can earn additional compensation for documenting that coronary artery disease care is tracked on a flowsheet.

The flowsheet must be organized to trend results over time and remind the practitioner that a service is due. The amount of the payment is contingent upon the percentage of members with diabetes for whom management of specific risk factors is tracked on a flowsheet.

For the three years prior to implementation of this program, the HEDIS Cholesterol Management "After Acute Cardiovascular Events" rate showed little change. In 2003, the first year of the program, the screening rate increased by 11 percentage points and the percentage of members with CAD with LDL <130 increased by eight percentage points.

Mental Health Program

In 2001, BCBSIL implemented a pay-for-performance program in which HMO medical groups/IPAs are rewarded based upon the percentage of members with a mental health admission having a follow-up visit with a behavioral health provider within 30 days of hospital discharge.

Each year since implementation, the mental health follow-up visit rate has increased. The rate has consistently been well above the Quality Compass national average.