Quality Improvement



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The BCBSIL Quality Improvement (QI) Program is based on the view that the process for delivery of medical care and services can be continuously improved. The information provided is a summary of the quality improvement programs in place for BCBSIL members and practitioners. Call 312-653-3465 with questions about the QI Program.




Blue Cross and Blue Shield of Illinois (BCBSIL) reports audited Healthcare Effectiveness Data and Information Set HEDIS results. HEDIS is a nationally standardized set of measures related to important areas of care and service. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health care performance measures in the United States.

 

2018 Annual HEDIS Reports

HMO

Each year, BCBSIL reports audited HEDIS results for HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare DirectSM and Blue FocusCareSM combined.

  

The 2018 BCBSIL HMO HEDIS Report, which is based on 2017 data using HEDIS 2017 specifications, includes measures across domains of care that reflect effectiveness of care, access/availability of care and utilization. The 2018 Quality Compass National Average rates are also included in this report for comparison of the BCBSIL HMO performance to the performance of other commercial health plans.

  

View the 2018 HMO HEDIS results  

 

PPO

The 2018 BCBSIL PPO HEDIS results have been audited. They are based on 2017 data using HEDIS 2017 specifications, and include members residing in Illinois. The 2018 Quality Compass National Average rates are provided for comparison of the BCBSIL PPO performance to the performance of other commercial health plans.

 

View the 2018 PPO HEDIS results 

 

Additional Information

To learn more about the HMO Illinois, Blue Advantage HMO, Blue Precision HMO, BlueCare Direct and Blue FocusCare Quality Improvement (QI) program, including goals, processes and outcomes related to member care and service, view the QI Executive Summary or call 312-653-3465 to request additional information about the QI program.

 

HEDIS is a registered trademark of NCQA.


Blue Cross and Blue Shield of Illinois (BCBSIL) reports audited Healthcare Effectiveness Data and Information Set (HEDIS) results annually. HEDIS is a nationally standardized set of measures related to important areas of care and service. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health care performance measures in the United States.

 

2018 HEDIS Results for Blue Cross Community MMAI (Medicare-Medicaid Plan)SM, Blue Cross Community ICPSM and Blue Cross Community Family Health PlanSM (FHP)

 

The 2018 BCBSIL Medicaid HEDIS Report reflects the care given to our members in 2017 using the HEDIS 2017 specifications. The following are the 2018 HEDIS results:

  • MMAI: Out of 55 HEDIS measures, seven showed statistically significant improvements from the previous year and 13 of the measures met either the state-defined or the Centers for Medicare & Medicaid Services (CMS) goal
  • ICP: Out of 21 HEDIS measures, four showed statistically significant improvements and six of the measures met the NCQA or state-defined goal
  • FHP: Out of 29 HEDIS measures, 12 showed a statically significant improvement and seven of the measures met the NCQA or state-defined goal

2019 HEDIS Results

 

IL Medicaid

Each year, BCBSIL reports the audited HEDIS results for Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM to the Illinois Department of Healthcare and Family Services (HFS), Centers for Medicare & Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA).

  

BCBSIL will report HEDIS rates based on 2018 data. The 2019 HEDIS specifications include measures across domains of care that reflect Effectiveness of Care and include preventive screenings, respiratory and cardiac conditions, diabetes, behavioral health and other areas. It also includes measures pertaining to access/availability of care, experience of care along with utilization and risk adjusted utilization. 

 

The following guidelines have been developed to aid providers in documenting all required elements in the member’s medical record, which will assist in review of the record during the 2019 HEDIS audit.

Resources

HEDIS is a registered trademark of NCQA.


BCBSIL requires an on-site office visit at least every three years for primary care physicians (PCPs), including OB/Gynes and pediatricians, for continued participation in the HMO product. High-volume behavioral health specialists are reviewed for the HMO product for the purposes of credentialing. An on-site visit is not required for practitioners participating with PPO products. BCBSIL may perform an on-site visit more frequently than every three years for quality improvement purposes and as a result of a complaint. The current BCBSIL site visit standards used for auditing are available for you to print.

Site Visit Reports:

Behavioral Health Site and Medical Record Audit

PCP Site and Medical Record Audit

 

HMO Site Visit Summary:

Annual HMO Medical Site Visits 

Annual HMO Behavioral Health Site Visits 

 

HMO Quality Site Visit Standards:

HMO Quality Site Standards - Full Version 

HMO Utilization Management Plan