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BCBSD Quality Improvement Program
Blue Cross Blue Shield of Delaware (BCBSD) is pleased to share with our
members the ways we work to enhance the services we offer. The purpose
of the BCBSD Quality Improvement (QI) Program is to continuously:
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Monitor and improve the quality and safety of
medical and behavioral health care provided to members, including
identification and development of actions to address disparities
based on age or gender
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Monitor and improve service delivery to members and
providers
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Evaluate and take actions to improve the medical and
mental health status of members
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Educate members, practitioners and organizational
providers about improving the clinical safety of health care
services
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Identify opportunities and monitor effectiveness of
interventions to improve member programs, services and health
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Reduce over- and under-utilization of health care
resources, as utilization levels can often be an indication of poor
quality of care and/or a barrier to access to care
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Benchmark BCBSD’s performance with similar
organizations by participation in HEDIS®'
(Healthcare Effectiveness Data and Information Set), CAHPS®†
4.0 (Consumer Assessment of Health Plans Survey), Member TouchPoints
and other selected benchmarking activities
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Ensure compliance with applicable national standards
regarding network performance, including those published by the
National Committee for Quality Assurance (NCQA) and the American
Accreditation Health Care Commission (URAC)
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Provide a corporate culture that promotes continuous
quality improvement
We invite you to submit comments regarding our QI
process, or you can request copies of BCBSD’s QI Program description and
evaluation by sending a written request to:
Blue Cross Blue Shield of Delaware
Attn: Director of Quality Improvement
P.O. Box 1991
Wilmington, DE 19899-1991
Measuring Our Performance
Each year, BCBSD’s quality practices are reviewed in two ways:
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HEDIS – measures the effectiveness of care for
specific health practices, such as immunizations, postpartum
check-ups and use of antidepressants
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CAHPS – measures performance in areas such as
customer service, claims processing and health plan rating
The results of these reviews can help you compare the
performance of different managed care plans. These results also help
determine the level of accreditation BCBSD receives from the NCQA.
To see the results, you can
download the entire report
as a .pdf file, which can be viewed and printed on any computer using
free Acrobat Reader software. Don’t have Acrobat Reader?
Get
it here.
®' HEDIS is a registered trademark of
NCQA.
®† CAHPS is a registered trademark of the Agency for Healthcare Research
and Quality (AHRQ).
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