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 progams.

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See what we’re doing about coronavirus

With the spread of novel coronavirus in the U.S., we’re adapting for our members’ health. Here’s what you need to know.

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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 participation in Commercial Quality Improvement. To keep you informed of changes and support your success, we provide a variety of publications, services and events. The Provider Resource Guide offers a quick overview of the resources we offer, and our annual Quality Care Measures Guide includes information and tips to help you close HEDIS® measures for your patients.

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.

Medical Home Partnership (MHP)

Launched in January of 2020, the MHP program is designed to provide better health outcomes and value for BlueCross members at every stage of their health care continuum. Building off the success of our former PCMH program, which focused on chronic condition management, the MHP continues to reinforce the value of care coordination, quality improvement and utilization management.

To participate, 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 certification and meet annual submission requirements.

Clinical Resources

Member 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.

Quality+ Partnership Program


Risk Adjustment Guides


Pharmacy Guides

Support Programs


Risk Adjustment Guides


Pharmacy Guides

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.

Clinical Resources

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Tennessee Health Care Innovation Initiative (THCII)

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.

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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.

Learn More