• Communications

• Policies and Guidelines

• Claims and Billing

• Interactive Tools and Resources

• Pharmacy Information

• Resources for Patient Management

• H1N1 Information
• Quality Management
• Worksheets, Forms, and Guides
• Internet Resources & Bulletins
• Interventions and Reminders
• Healthy Lifestyles
• Connections Health Management Programs
• SilverSneakers Fitness Program
• Case Management

• Physician Advisory Committee

• Contact Information

Quality Management Program

Independence Blue Cross’ Quality Management (QM) program provides a formal process to systematically monitor and objectively evaluate the company’s quality, efficiency, and effectiveness.

Program Activities

• Provide tools and information to assist network providers in developing and maintaining a standard of care.
• Manage partnerships with network providers.
• Monitor and evaluate care.
• Suggest improvement to medical policies.
• Oversee credentialing.
• Oversee various processes for hearing grievances and appeals.
• Collect member suggestions for quality initiatives.
• Monitor aspects of care based on the demographics of members served (i.e., age, sex, and health status).
• Investigate and track potential quality of care concerns through the recredentialing, grievance and appeal, and peer review processes.

Member Safety

We use plan-wide activities that increase member safety initiatives and reduce medical/medication errors. These activities include communicating information through mailings and newsletters.

Member Satisfaction

We investigate and resolve all quality of care and quality of service issues. Members may file a concern/complaint in writing or by calling Member Services at the number listed on back of the ID card.

Continuity and Coordination of Care

We assess continuity and coordination of care through three important aspects:

• coordination among medical providers treating the same patient;
• coordination between medical and behavioral care;
• monitoring for potential unavailability of access to care when a provider leaves a network and has patients in active treatment.

When a member is receiving an active course of treatment and his/her practitioner terminates from the health plan, the member may be eligible for continued access to the practice for a time period mandated by specific state regulations. The health plan will notify the member in writing of the termination and assist the member in arranging the continuation of care and selection of a new practitioner.

Quality Improvement

Information about our Quality Improvement program is available to members and providers. Upon request, we’ll provide a description of our program and a report on progress.

Provider requests, call 1-800-227-3119 for HMO or 1-800-332-2566 for PPO. Member requests, call the Member Services number listed on back of the ID card.

Additional information can be found in our Partners in Health Update.

Quality Management Program Information

• IBC Quality Management Information