Connecting for quality
Health care is about connecting patients to doctors, members to caregivers and systems to systems. Blue Cross and Blue Shield of Kansas (BCBSKS) is connected by financing quality health care that meets your needs. We offer a host of health and wellness programs and services designed to help improve health, and connect members with the right care at the right time.
Our quality programs and initiatives are grounded in:
- System-wide focus on quality
- Data collection
- Employing best practices
- Engaging and connecting with members and providers in the process
Quality of care and member satisfaction is promoted through:
- Education and preventive care programs to help our members stay well and avoid chronic diseases
- Members getting the right care at the right time in the right setting
- Access to care
- Connecting members with service providers when needed
- Measuring and studying where, when, and how our members use health care services
Blue Cross and Blue Shield of Kansas members have access to tools to help them search for urgent care, review and compare doctors and estimate costs for health care services.
Access these tools by using our provider directory and cost tool. To receive personalized results, log in with your name, ID number, group number and birth date. After logging in, you'll find access to these tools:
- Cost estimator tool - By using data from the Blue Cross Blue Shield Association National Consumer Cost Tool (NCCT), members are able to compare providers and prices to find the best value care.
- Patient review of physicians - Members have the ability to read and write reviews of physicians and professional providers nationwide.
- Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) - HCAHPS is a national, standardized patient satisfaction survey for hospitals run by the Centers for Medicare and Medicaid Services (CMS). Results from these surveys, as well as reviews from other Blue Cross Blue Shield members, are shown to members to help evaluate providers based upon prior patient experience and satisfaction.
A value-based program is an arrangement with health care providers where a portion of provider reimbursements are based on quality and cost outcomes. The types of value-based programs that are available to our BCBSKS network providers include Patient-Centered Medical Homes (PCMH), Accountable Care Organizations (ACO), and Pay-for-Performance (P4P) arrangements.
Quality Based Reimbursement Program (QBRP)
BCBSKS administers a pay-for-performance program referred to as QBRP that is designed to promote efficient administration, improved quality, and better patient care and outcomes. Even though participating providers must meet certain prerequisites, the program is available to all eligible CAP professional and institutional providers.
Patient-Centered Medical Home (PCMH)
PCMH establishes a partnership between the patient and Primary Care Physician (PCP). BCBSKS launched a three-year PCMH pilot program sponsored by Kansas Primary Care Professional Organizations and the Kansas Academy of Family Physicians (KAFP) in 2011. In 2013, the pilot concluded and BCBSKS launched the BCBSKS Systematic Transformation to Excellence in Medicine (BlueSTEM) program. Through BlueSTEM, the performance of participating PCPs is measured, scored, and used to reimburse providers based on quality outcomes. The BlueSTEM model supports the five primary functions of a PCMH:
- Comprehensive care
- Patient-centered care
- Coordinated care
- Accessible services
- Quality and safety
Accountable Care Organizations (ACO)
An ACO is an integrated health system, or a network of PCPs, hospitals, health care providers (i.e. specialists) who agree to deliver effective (quality) and efficient (cost) care. ACO arrangements are designed to encourage coordinated care and meet performance benchmarks for quality and affordability in order to manage the total cost of care of their (attributed) patient population.
- Blue Distinction Total Care is a national designation program that recognizes doctors and hospitals for their efforts in coordinating total patient care, and have met nationally consistent criteria for patient-centered and value-based care.
- Blue Distinction Specialty Care is a national designation program recognizing health care facilities that demonstrate expertise in delivering quality specialty care safely, effectively, and cost-efficient. The goal of the program is to help consumers find both quality and value for their specialty care needs. The Blue Distinction Specialty Care program includes two levels of designation
- Blue Distinction Centers – Health care facilities recognized for expertise in delivering quality specialty care.
- Blue Distinction Center+ – Health care facilities recognized for expertise in delivering quality and cost-efficient specialty care.
BCBSKS establishes quality initiatives that encourage the consumers and providers to work together to improve health outcomes and control health care costs. All clinical quality improvement projects enlist the input of clinical leadership staff members and at least one participating provider for clinical quality measures and/or clinical aspects of performance.
Reporting on performance measures ensures quality indicators for assessing the achievement of outcomes are monitored and used to support performance improvement initiatives, reporting to customers, reporting to providers, or reporting to government agencies.
The National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) is an industry tool that BCBSKS uses to manage the delivery of quality programs. Health plans use HEDIS data to identify opportunities to improve quality, as well as measure health outcomes. HEDIS data is gathered from claims, medical record reviews and surveys. HEDIS data analyzes public issues such as cancer, heart disease, asthma, diabetes, and use of preventive services.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is a program that gauges a member's experiences with the health care system and delivery of care. Health plans report survey results to help identify opportunities to improve quality and the patient's health care experience.
The Choosing Wisely® Campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation, encourages conversations between physicians and patients to improve care. National medical specialty societies have created lists of specific, evidence-based recommendations intended to spark discussion between clinicians and patients. Some topics in the list include dangers of overuse of tests/procedures.
Choosing Wisely® aims to promote conversations between clinicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
BCBSKS operates a credentialing program that ensures network providers meet the standards of professional licensure and certification. The process enables BCBSKS to recruit and retain a quality network of providers to serve its members and offer ongoing access to care. Routine monitoring of provider credentials ensures the network is made up of providers with the ability to successfully manage the health care of members in a cost-effective manner.
Provider credentialing criteria:
- Professional providers (UPDATED LINK NEEDED)
- Institutional providers