NCQA Names Blue Plus One of Top Five Health Plans in Region.Business Editors/Health/Medical Writers EAGAN, Minn.--(BUSINESS WIRE)--Sept. 22, 2003 The National Committee for Quality Assurance National Committee for Quality Assurance Medical practice A private, not-for-profit organization which has become the leading accreditor of managed care plans; in site visits, NCQA reviewers evaluate a managed care plan in terms of quality management, physicians' (NCQA NCQA National Committee on Quality Assurance, see there ) has named Blue Plus one of the five best-performing commercial health plans in the seven-state West North Central region, based on HEDIS HEDIS Health Plan Employer Data & Information Set Managed care An initiative by the National Committee on Quality Assurance to develop, collect, standardize, and report measures of health plan performances. (R)(1) Effectiveness of Care measures. HEDIS is the measurement tool used by the nation's health plans to evaluate their performance in terms of clinical quality and customer service. NCQA made the announcement in its 2003 State of Health Care Quality report issued today. The report analyzed care and service data on commercial and Medicaid/Medicare health plans, including Blue Plus' commercial, MinnesotaCare and Prepaid Medical Assistance Program membership. Blue Plus is the Blue Cross and Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. of Minnesota HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, . "We are proud to have been chosen as one of the top five plans. We continually work to improve the health of our members, and we are very pleased to see our work reflected in this honor," said Steven W. Richards, M.D., vice president of health care improvement at Blue Plus and Blue Cross. Earlier this year, NCQA again awarded Blue Plus an accreditation status of "Excellent" -- the highest level achievable -- for the health plan's commercial business (HMO/POS), Prepaid Medical Assistance Program and MinnesotaCare programs. NCQA Accreditation not only involves a rigorous review of a health plan's consumer protection and quality improvement systems, but also requires health plans to submit audited data on key clinical and service measures (e.g., mammography mammography, diagnostic procedure that uses low-dose X rays to detect abnormalities in the breasts. The early diagnosis of breast cancer made possible by the routine use of mammography for screening women increases a woman's treatment alternatives and improves her screening rates; advising smokers to quit; consumer satisfaction). In addition to Blue Plus' ongoing work in member health improvement, the health plan attributes a portion of its success to several key initiatives in Minnesota because it believes clinical improvement occurs only in collaboration with health care providers: -- Collaboration with Minnesota's provider groups and other health plans in standardizing clinical practice guidelines clinical practice guidelines Clinical policies, practice guidelines, practice parameters, practice policies Medtalk Systematically developed statements to assist practitioner and Pt decisions about appropriate health care for specific clinical circumstances. See Psychology. , evidence-based medicine evidence-based medicine Decision-making 'The use of scientific data to confirm that proposed diagnostic or therapeutic procedures are appropriate in light of their high probability of producing the best and most favorable outcome'. See Meta-analysis. and quality improvement through the Institute for Clinical Systems Improvement (ICSI ICSI - International Computer Science Institute at Berkeley, CA. ) -- Collaborative community health care delivery measurement through the Minnesota Council on Health Plans, to support quality initiatives of providers and ICSI to improve care; to reduce administrative burden for medical groups, health plans, and regulators; and to communicate findings in a fair and reliable way to medical groups, regulators, purchasers, and consumers Blue Cross and Blue Plus also recently announced two new incentive programs -- Recognizing Excellence and Assisting Smokers to Quit -- in which the health plans reward providers for excellent performance in clinical outcomes. The new approach will improve the health of Blue Cross and Blue Plus members, thereby ensuring that better health outcomes are recognized and reimbursed accordingly. The programs will initially address health outcomes in the areas of diabetes, hypertension, cardiac care, asthma, otitis media Otitis Media Definition Otitis media is an infection of the middle ear space, behind the eardrum (tympanic membrane). It is characterized by pain, dizziness, and partial loss of hearing. , pap smears, chlamydia chlamydia (kləmĭd`ēə), genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, screening, and tobacco dependence. The other health plans to receive NCQA "Top 5" status in the West North Central region are HealthPartners (MN), Medical Associates Health Plan, Inc. (IA), UnitedHealthcare of the Midlands, Inc. (NE), and Wellmark Health Plan of Iowa, Inc. (IA). HEDIS is a tool used by most of America's health plans to measure performance on important dimensions of care and service. HEDIS is designed to provide purchasers and consumers with the information they need to reliably compare the performance or managed health care plans. HEDIS results are based on a statistically valid random sample of members. Results are rigorously audited by certified auditors using a process designed by NCQA. NCQA is an independent, nonprofit organization dedicated to measuring the quality of America's health care. NCQA accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans. Blue Cross and Blue Shield of Minnesota, with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota's first health plan and continues to carry out its charter mission today: to promote a wider, more economical and timely availability of health services for the people of Minnesota. A not-for-profit, taxable organization, Blue Cross is the largest health plan based in Minnesota, covering 2.6 million members in Minnesota and nationally through its health plans or plans administered by its affiliated companies. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association
(1) HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). |
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