Quality Improvement Program Review
Blue Cross of Northeastern Pennsylvania (BCNEPA) improves the health of our
membership through delivery of quality, cost effective and accessible health
care services while building effective partnerships with our customers. The
Quality Improvement (QI) Program monitors and evaluates outcomes of care and
services and then plans interventions that will continuously improve the level
of care and service provided to our members.
The Quality Improvement Committee (QIC) oversees the QI Program. QIC is made up
of BCNEPA employees and local medical and behavioral health doctors. Each year,
the program is evaluated and opportunities to improve the services we provide
and the health of our members are identified and plans are developed to move
toward those goals.
The QI Program is evaluated annually to see how well the goals are being met.
Both the clinical and service activities that the health plan undertakes to
improve health outcomes and member access to benefits and services are included
in the evaluation. The evaluation is used to identify further actions to
improve the care and services available to our members.
2006 QI Program Accomplishments:
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Achieved URAC accreditation for our case management department
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Eliminated referrals from PCPs to in-network specialists
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Developed a network for nutritional counseling
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Developed and implemented disease management programs for chronic obstructive
pulmonary disease and heart failure
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Organized collaborative initiatives with physicians and hospitals to improve
patient safety
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Targeted clinical quality improvement initiatives for breast cancer screening,
diabetes, hypertension, respiratory conditions and behavioral health care
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Implemented a pay for performance program for network PCPs who meet/exceed
selected care standards
2007 Goals
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Maintain NCQA Excellent Accreditation status
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Improve member awareness and access to preventative health care and recommended
screening services
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Increase member satisfaction with inquiry and call resolution
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Increase number of patients having retinal eye exams
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Increase the coordination of care between PCPs and specialists to improve
efficiency and effectiveness of members' care and services
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