Quality improvement
Blue Cross Blue Shield of Massachusetts is committed to providing access to the highest-quality health care and health management services for our members.
What is quality health care?
We believe you and your family should have health care that is:
- Safe
- Based on the best scientific information available
- Delivered at the right time
- Respectful of your needs and preferences
- Careful to avoid waste
- Fair and affordable every time
Quality improvement program
We have created a Quality Improvement Program that reviews every area that could affect your care from our member services and care management teams to our extensive network of doctors, hospitals, and specialty care providers.
Accreditation
Accreditation is the official recognition, by an independent organization, of our commitment to quality. Since 1995, we have worked with the National Committee for Quality Assurance (NCQA) to evaluate our Quality Improvement Program.
Strong partnerships
Doctors, clinicians, and hospitals
We believe that doctors and hospitals should be rewarded for delivering high-quality patient care and for helping to keep you healthy. Programs like our Alternative Quality Contract, and Hospital Performance Improvement Programs promote quality by recognizing doctors and hospitals for the quality of care they provide our members.
External partners and advisors
We seek external input and advice about our Quality Improvement Program from practicing doctors to broaden our perspective and stay connected to our extensive network of providers as well as current and non-Blue Cross members who provide us with feedback on the important aspects of their health care. We do this by inviting our members and medical and behavioral health professionals to join us on various Quality Improvement committees.
Blue Cross Blue Shield of Massachusetts has a long-standing history of participation in statewide quality improvement initiatives administered by the Massachusetts Health Quality Partners (MHQP). MHQP is a broad-based coalition of doctors, hospitals, health plans, purchasers, patient and public representatives, academics, and government agencies working together to promote improvements in health care quality and services in Massachusetts. Blue Cross Blue Shield of Massachusetts currently participates in MHQP's Clinical Quality results and Patient Experience Survey biennial projects.
Implementation, evaluation, and measurement
Each year our Quality Improvement Program teams develop a set of quality improvement initiatives and evaluate the effectiveness of those initiatives so that we can plan for the next year. That's how we set the stage for continuous improvement.
Health management programs
At Blue Cross Blue Shield of Massachusetts, we're committed to facilitating access to health management services that help improve our members' health, enhance clinical quality outcomes, and decrease the cost of health care. We help members address:
- Medication management
- Self-care management
- Smoking cessation
- Healthy eating
- Health care appointment adherence
- Behavioral health
- Exercise
- Stress management
Case Management
Led by experienced registered nurses, our Case Management program helps members with complex care needs associated with severe illness, injury, or other conditions, by coordinating health care services and providing education to promote self-management for their particular condition. The program aims to help members improve their health status and quality of life, and to lower rates of complications, emergency room visits, inpatient admissions, and readmissions.
For more information, please call our Clinical Coordination Department at 1-800-392-0098.
Prevention screening reminders
Preventive screenings are one of the most important components of regular preventive care. To help our members stay current with their covered screenings, we provide communications for both mammograms and colorectal cancer screenings.