Quality Resources

Like you, we want to ensure our members – your patients – have access to quality care. Our Quality Improvement program supports that goal. It uses data and other tools to measure quality across all  aspects of care, including effectiveness, access, availability and utilization.

The quality data you provide helps us identify opportunities that could improve our members’ care, such as preventive screenings and chronic care management.

Below is information about our quality improvement program, tools we use to measure performance and resources for you. If you have questions:

  • Healthcare Effectiveness Data and Information Set (HEDIS®) Measures 

    We use HEDIS measures to track performance on important areas of care. More than 90% of health plans in the U.S. use these measures from the National Committee for Quality Assurance.

    To access our tip sheets on the measures: Sign in to Availity® Essentials and visit our Payer Spaces. You can download our tip sheets from the Resources section under Quality Improvement. Topics the tips sheets cover include:

    • Behavioral health
    • Breast and colorectal cancer screening
    • Controlling high blood pressure
    • Immunizations
    • Diabetes care, including glycemic status assessment, eye exams, statin therapy and kidney health evaluations
    • Prenatal and postpartum care
    • Well-child visits

  • HEDIS Results for Commercial Networks

    We report audited HEDIS results each year for our commercial HMO and PPO networks.

    The latest reports are based on 2023 data using HEDIS measurement year 2023 specifications. They include 2023 Quality Compass National Averages to compare our networks’ performance to the performance of other health plans:

     

    Blue Star Medical Group/IPA Report: This report recognizes high-performing medical groups or independent practice associations that serve our HMO members. View the 2024 report.

  • HEDIS Data for Medicaid

    We collect HEDIS data annually from our providers for Blue Cross Community Health PlansSM and Blue Cross Community MMAISM. The results are sent to the Illinois Department of Healthcare and Family Services, Centers for Medicare & Medicaid Services and the National Committee for Quality Assurance.

  • Member Health Care Experience Surveys

    Every year, some of our members receive surveys to collect information about their experiences with their health care providers and health insurance plans. The results help identify opportunities for improving member satisfaction.

    If you get questions from members who received a survey, please encourage them to respond.

    Consumer Assessment of Healthcare Providers and Systems Survey: Conducted February through June, the survey asks members ages 18 and older to rate their last six months of care. Learn more about the survey for:


    Qualified Health Plan Enrollee Experience Survey: Conducted February through June, the survey asks members in marketplace plans to rate their experiences with their health plan and provider.

    Health Outcomes Survey: Conducted August through November, the survey gathers health status data from Medicare Advantage members to support quality improvement. Learn more.

    For more details about the surveys, refer to:

Related resources

For Medicaid providers

 

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois.

CAHPS is a registered trademark of AHRQ.

HEDIS is a registered trademark of NCQA. Use of this material is subject to NCQA’s copyright, found here.

BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.