Quality

  • You+Blue

Our goal is to deliver quality health care to meet our members’ needs. Our vision is to build and strengthen relationships among our members and communities to improve health and quality of life.

Improving health outcomes of members is the aim of the entire BlueCare Tennessee organization. Every employee plays a role. All of our employees work together toward the same quality goals. We look for local solutions to achieve the meaningful results you need.

BlueCare Tennessee works to match our services to our members’ health needs. Quality services and member safety are our top concerns.

Our quality effort has four parts:

  • System-wide focus on quality
  • Complete data collection
  • Finding best practices for quality and putting them into action
  • Engagement of all member and provider facing areas

Quality of care and member satisfaction is promoted through:

  • Education and preventive care programs to help our members stay well and avoid or delay the start of chronic diseases
  • Getting our members the right care, at the right time
  • Improving access to health care
  • Connecting physical health care, behavioral health care and long-term services where needed
  • Measuring and studying where, when and how our members use health care services

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a set of quality measures. HEDIS was set up to give the public information to compare how different health care plans improve their members’ health outcomes.

Health care plans are required to collect and report HEDIS data by:

  • Centers for Medicare and Medicaid Services (CMS)
  • Groups like the National Committee for Quality Assurance (NCQA®)
  • Many states

HEDIS data is connected to many public health issues such as:

  • Cancer
  • Heart disease
  • Asthma
  • Diabetes
  • Use of preventive health services.

HEDIS data is used by health plans to find where they can improve quality. It also helps health plans measure how well we are doing at improving our members’ health outcomes.

How is HEDIS data gathered? There are three data collection methods:

  • Administrative (Information from claims and interactions with members)
  • Hybrid (Medical record review on a sample of members, along with claims and interactions with members)
  • Survey