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Health Care Quality Improvement Overview

The following information details Quality Improvement Initiatives undertaken by our health plan.

BlueCross BlueShield of WNY programs provide health care services to keep our insurance customers healthy and help them to get well when they are ill.

BlueCross BlueShield of WNY promotes good, helpful and sensibly priced health care for all ages. We give our doctors the most up to date information in order to provide the best care. We work with our doctors to help patients feel well and know how to care for their health.

 

Participation in National Proven Quality Programs

National Committee for Quality Assurance Accreditation (NCQA)

BlueCross BlueShield of Western New York is accredited by a national quality agency called the National Committee for Quality Assurance (NCQA). This agency surveys us to make sure our members get good treatment and safe care to stay well. This helps keep health care costs lower.

Our 2017 NCQA accreditation status was “Excellent” for our Commercial and Medicare PPO products and “Commendable” for our Medicare HMO and Medicaid products.

Healthcare Effectiveness Data and Information Set (HEDIS®)

The Healthcare Effectiveness Data and Information Set (HEDIS®), developed and maintained by the NCQA, is a standardized measurement tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service:

  • Effectiveness of Care
  • Access/Availability of Care
  • Experience of Care
  • Utilization and Risk Adjusted Utilization
  • Relative Resource Use
  • Health Plan Descriptive Information
  • Measures Collected Using Electronic Clinical Data Systems

Because many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an “apples-to-apples” basis.

HEDIS results are collected and reported separately for populations covered by Commercial, Medicaid, Medicare, and Marketplace lines of business. HEDIS results are used to identify opportunities for improvement in the health care provided to our members, in addition to being used to evaluate the effectiveness of existing quality programs.

In 2016, HEDIS clinical measures, along with customer satisfaction survey results, contributed to the "Commendable" NCQA Health Plan Accreditation status for our Commercial, Medicare HMO and PPO products. 

Quality Assurance Reporting Requirements (QARR)

Quality Assurance Reporting Requirements (QARR) are reported to the New York State Department of Health and consist of measures from the NCQA, HEDIS, and New York State (adolescent preventive care, HIV/AIDS comprehensive care, and colorectal and lead screening).

In 2017, QARR was publicly reported for our Commercial, Medicaid, and Marketplace lines of business. QARR performance results assist our members and prospective members in choosing a health plan. These results are also used to identify service-improvement opportunities for evaluating existing and potential quality programs.