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Quality Management Program
Independence Blue Cross uses its Quality Management program to systematically monitor and objectively evaluate the company’s quality, efficiency, and effectiveness.
The following is a list of the Quality Management program’s main tasks:
- provide tools and information to assist network providers in developing and maintaining a high standard of care;
- manage partnerships with network providers;
- monitor and evaluate the care our members receive;
- suggest improvements to medical policies;
- oversee provider 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.
We use plan–wide activities that increase member safety initiatives and reduce medical and medication errors. These activities include communicating information through mailings and newsletters.
We take all member feedback seriously. We thoroughly investigate and aim to resolve all quality–of–care and quality–of–service issues. Any member may file a concern or complaint in writing or by calling Customer Service at the number listed on back of his or her ID card.
Continuity and Coordination of Care
We assess coordination and continuity of care against three criteria:
- how well care is coordinated among medical providers who are treating the same patient;
- how well medical and behavioral care are coordinated;
- when a provider leaves a network, how well we ensure that his or her patients under active treatment have continuous access to care.
When a member is receiving an active course of treatment and his or her practitioner leaves 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 that his or her provider has left the network and assist the member in arranging the continuation of care and selection of a new practitioner.
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 also be found in our Partners in Health Update.