QUALITY CARE INITIATIVES

Working Together to Provide the Highest Level of Care

We know you’re committed to providing quality care to your patients. Here’s the information you need to help maximize your performance in our quality progams.

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Quality Care Quarterly Newsletter

Learn how providers across Tennessee are creating successful quality practices, and get helpful tips and updates from our BlueCross quality teams.

Quality Care Initiatives

Quality Care Initiatives

Commercial

Quality Partnership

We value your participation in Commercial Quality Improvement. To keep you informed of changes and support your success, we provide a variety of publications, services and events. The Provider Resource Guide offers a quick overview of the resources we offer, and our annual Quality Care Measures Guide includes information and tips to help you close HEDIS® measures for your patients.

Quality Care Partnership Initiative (QCPI)

In 2018, BlueCross created the QCPI in an effort to build a network of Primary Care Providers (PCPs) committed to quality, and reimbursement based on objective, measurable quality outcomes. Participating PCPs are graded and reimbursed by their performance on evidence-based quality measures each year.

Medical Home Partnership (MHP)

Launched in January of 2020, the MHP program is designed to provide better health outcomes and value for BlueCross members at every stage of their health care continuum. Building off the success of our former PCMH program, which focused on chronic condition management, the MHP continues to reinforce the value of care coordination, quality improvement and utilization management.

To participate, PCPs must meet certain performance standards including taking part in the Commercial Quality Care Partnership Initiative and maintaining a 3-star rating. They must also achieve NCQA PCMH certification and meet annual submission requirements.

Clinical Resources

Member Resources

Medicare Advantage

Quality+ Partnership Program

We know you’re working hard to help our members get preventive screenings, effective treatment and improved access to necessary health services. We’re here to support and reward your efforts in providing quality, value-based care. Our Quality Program Information Guide includes a Quality+ Partnerships Program Overview for BlueAdvantage PPO and BlueEssential HMO SNP, important information about the current Quality Amendment Measures, and details about other resources available to you.

Quality+ Partnership Program


Risk Adjustment Guides


Pharmacy Guides

Support Programs

BlueCare Tennessee

Quality Initiatives

We appreciate your participation in our BlueCare Tennessee Quality Initiative programs. The Quality Measures Booklet features everything you need to know to maximize your performance for each quality measure. You'll also find information about the state's THCII program below. 

BlueCare Plus

Quality+ Partnership Program 

Since BlueCare Plus serves the needs of Medicare members who also qualify for Medicaid, it offers providers the same Quality+ Partnership program as Medicare Advantage. The Quality Program Information Guide provides comprehensive information about quality measures for your BlueCare Plus and BlueCare Plus Choice patients.

Clinical Resources

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Tennessee Health Care Innovation Initiative (THCII)

Led by the state of Tennessee, THCII was created to lower costs and improve health care for Tennesseans. The program is designed to shift the health care system from volume-based to value-based, while protecting our members’ physical and financial health by reducing ineffective or inappropriate treatments. In turn, doctors and hospitals are rewarded for delivering high quality, efficient medical care.

BlueCross Performance Rating

Rating system for Commercial Network Primary Care Providers

The BlueCross Performance Rating helps our members compare primary care providers by objectively rating how well they meet recognized health and wellness standards, deliver efficient care and manage patients' total health.

Learn More