Blue Medicare HMO Blue Medicare PPO

Quality Improvement Program

The Quality Improvement Program is an important component of our Blue Medicare HMO and Blue Medicare PPO products. The program improves quality by:

  • Fostering better health through innovative preventive programs
  • Delivering the right care, at the right time, in the right setting
  • Ensuring better medical outcomes for members
  • Providing hassle-free service
  • Improving affordability
  • Improving customer satisfaction
  • Caring for customers and communities

Consistent with current professional knowledge, Blue Medicare HMO and Blue Medicare PPO defines quality of care for individual populations as the degree to which health services increase the likelihood of desired health outcomes. Quality of service is defined as the ease and consistency with which customers obtain high quality care, as measured by customer perception and objective benchmarks. This includes appropriate access to care.

In determining the scope and content of its Quality Improvement Program, Blue Medicare HMO and Blue Medicare PPO recognizes the factors that influence the delivery of health care such as:

  • Quality of care and service is a crucial and integral component of health care delivery
  • Existing and potential customers’/groups’ unique needs and expectations must be satisfied and exceeded
  • Provider relationships with patients and the Plan must be continually improved
  • Legislative and regulatory requirements must be met

The Quality Improvement Program is ongoing and designed to be proactive. It objectively and systematically monitors the quality and appropriateness of the care, service and access provided to members through our provider networks. The Program then identifies, implements and follows appropriate interventions to improve the quality of care and service. In other words, the QIP is designed to link the concern for quality and the demonstrated improvement. The program goals are to:

  • Support corporate objectives and strategies, especially cost-effectiveness and efficiency, while continuously improving care and service delivered to our members
  • Increase the accountability for results of care and service
  • Maintain member confidentiality, dignity and safety as they seek and receive care

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.