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
Consumer Transparency Tools
Whether you’re searching for urgent care, need to make an appointment with a doctor or want to see ratings on doctors or hospitals, our provider directory tool is meant to make the process easier.
Use our provider directory and cost tool to search for providers in your network including doctors, clinics, hospitals and more. Search by provider specialty or by the provider’s name, using your current location or a specific area. The type-ahead feature will suggest the names of providers, procedures and specialties to assist you with your search.
Consumer Cost and Member Out-of-Pocket Estimator tool:
- BCBSA National Consumer Cost Tool (NCCT) -- The purpose of NCCT is to enable members to obtain information on estimated costs for health care services.
- Member Out-of-Pocket (MOP) -- A way for members to obtain an estimate for out-of-pocket liability for health care services nationwide. The approach is to enhance NCCT data with detailed service-line costs to enable calculation of the out-of-pocket estimate. Blue Plans will use the detailed service-line cost data in conjunction with member benefits and accumulators to calculate member out-of-pocket estimates. The availability date for this feature has yet to be determined.
- Cost Estimator Tool -- The purpose of the cost estimator tool is to enable members to obtain estimated costs for health care services.
Patient Experience tool:
- Patient Review of Physicians (PRP) -- A member tool for reading and writing reviews of physicians and professional providers nationwide.
- Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) -- The current standard for hospital patient experience, survey results are available from the Centers for Medicare & Medicaid Services (CMS).
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-efficent. The goal of the program is to help comsumers 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.
Quality Measurement Reporting
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.
Tools for Measuring Quality
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.
Choosing Wisely® with Quality Connections
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
Our accreditations, listed here, demonstrate our commitment to quality.
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: