QUALITY CARE INITIATIVES
Working Together to Provide the Highest Level of Care
We know you’re committed to providing quality care to your patients. Here’s the information you need to help maximize your performance in our quality programs.
Quality Care Quarterly Newsletter
Learn how providers across Tennessee are creating successful quality practices, and get helpful tips and updates from our BlueCross quality teams.
Quality Care Initiatives
Quality Care Initiatives
Commercial
Quality Partnership
We value your partnership in Commercial Quality Improvement. To keep you informed of changes and support your success, we provide a variety of publications, services and events. The Quality Care Measures & Comprehensive Program Information Guide includes information and tips to help you close HEDIS® measures for your patients. It also includes quick references, detailed clinical resources and overviews of other resources we offer.
Quality Training and Measures Overview
Quality Care Partnership Initiative (QCPI)
In 2015, BlueCross created the Quality Care Partnership Initiative (QCPI) in an effort to build a network of primary care physicians (PCPs) who are committed to quality, and agree to reimbursement that’s based on objective, measurable quality outcomes. QCPI is designed to improve the clinical quality, patient experience, and value of health care. Performance on these measures will influence the PCPs’ reimbursement for the next year.
Quality Care Partnership Initiative Program Guide
Medical Home Partnership (MHP)
In 2009, BlueCross began working with primary care providers to implement the Patient-Centered Medical Home (PCMH) program. The PCMH model of care highlights the importance of the health care team and the patient's role in their own health. The goal is to improve coordination of care among the medical system, community, family and patient resulting in better outcomes and patient satisfaction.
Between 2009 and 2019, the BlueCross PCMH program emphasized chronic condition management and primary prevention. Building off the success of the PCMH program, BlueCross launched the MHP program in 2020. The MHP program continues to reinforce the value of care coordination, quality improvement and utilization management. Participating PCPs must meet certain performance standards including taking part in the Commercial Quality Care Partnership Initiative and maintaining a 3-star rating. They must also achieve NCQA PCMH Recognition and meet annual submission requirements.
Medical Home Partnership Program Guide
Clinical Resources
Cultural Competency in Health Care
Antibiotic Stewardship Resources
Explore the CDC training on antibiotic stewardship to gain insights on appropriate use and managing patients’ expectations. Additional resources and patient education can be found within the training, and free CEUs are also available.
Antibiotic Stewardship Toolkit
CDC Training on Antibiotic Stewardship
Immunizations for Adolescents (IMA) Resources
Medicare Advantage
Quality+ Partnership Program
We know you’re working hard to help our members get preventive screenings, effective treatment and improved access to necessary health services. We’re here to support and reward your efforts in providing quality, value-based care. Our Quality Program Information Guide includes a Quality+ Partnerships Program Overview for BlueAdvantage PPO and BlueEssential HMO SNP, important information about the current Quality Amendment Measures, and details about other resources available to you.
Guide to Advanced Illness and Frailty Exclusions
Quality+ Partnership Program
Medicare Advantage 4 STAR and Above Providers
Stars Calculator and Cut Points
Opportunities to Connect with Our Medicare Advantage Members Using Telehealth
Medicare Advantage Transitions of Care Measures Booklet
Risk Adjustment Guides
Risk Adjustment Documentation and Coding for Dementia
Pharmacy Guides
Medication Therapy Management Program
Part B Step Therapy Provider Reference Guide
Differences Between Statin Star Measures
Statin Therapy for Patients with Cardiovascular Disease Measure
Statin Use in Persons with Diabetes Measure
Support Programs
BlueCare Tennessee
Quality Initiatives
We appreciate your participation in our BlueCare Tennessee Quality Initiative programs. The Quality Measures Booklet features everything you need to know to maximize your performance for each quality measure. You'll also find information about the state's THCII program below.
BlueCare Plus
Quality+ Partnership Program
Since BlueCare Plus serves the needs of Medicare members who also qualify for Medicaid, it offers providers the same Quality+ Partnership program as Medicare Advantage. The Quality Program Information Guide provides comprehensive information about quality measures for your BlueCare Plus and BlueCare Plus Choice patients.
Quality Program Information Guide
Provider Reimbursement Opportunities
Clinical Resources
Tennessee Health Care Innovation Initiative (THCII)
Led by the state of Tennessee, THCII was created to lower costs and improve health care for Tennesseans. The program is designed to shift the health care system from volume-based to value-based, while protecting our members' physical and financial health by reducing ineffective or inappropriate treatments. In turn, doctors and hospitals are rewarded for delivering high-quality, efficient medical care.
MORE ABOUT the Commercial THCII Program
THCII Episodes of Care Resources
Risk Adjustment Guides
Thresholds for Fully Insured Plans
Thresholds for State Employee Health Plans
BlueCross Performance Rating
Rating system for Commercial Network Primary Care Providers
The BlueCross Performance Rating helps our members compare primary care providers by objectively rating how well they meet recognized health and wellness standards, deliver efficient care and manage patients' total health.