2010 Quality Improvement Program Evaluation Summary

BlueCross and BlueShield of North Carolina (BCBSNC) conducts an annual evaluation of its Quality Improvement Programs to: review effectiveness, assess goal achievement, evaluate the deployment of resources, trend clinical and service indicators, assess outcomes of quality improvement initiatives in quality of care and service, document and trend input from advisory groups and other stakeholders, and identify opportunities for improvement in the ongoing provision of safe high-quality care and service to members. This report summarizes the evaluation findings of BCBSNC data from January 1, 2010 through December 31, 2010.

Notable Findings

Overall, the QI Program met or exceeded 90% of the 251 goals outlined. The BCBSNC PPO Rating of Health Plan is in the 50th ranking percentile.

QI program improvements were demonstrated in the following preventive care services: Breast Cancer Screenings, Childhood Immunizations, Colon Cancer Screenings, and the Flu Shot Campaign. Improvement was also identified with mental health hospitalization follow-ups, as well as comprehensive diabetes eye care and cholesterol screenings. Member access and service goals were exceeded, especially in the areas of Enrollment and Claims Operational Performance. The Bridges to Excellence for ASO performance program concluded in 2010 with increased NCQA recognitions in North Carolina. In addition to these successes, improvement in member satisfaction was achieved with our Asthma, Specialty Care, CAD, and Child Healthy Weight Member Health Partnership modules.

The 2010 Plan results indicate that member satisfaction could be improved in areas of our Health Line Blue Nurse Line, Getting Care Quickly and Getting Needed Care, Diabetes, Pregnancy, Migraine, CHF, Tobacco Free, Adult Healthy Weight, High Cholesterol and Hypertension, and Stress Member Health Partnership modules.

Highlights & Accomplishments

  1. Breast Cancer Screenings:

    The 2010 BCBSNC rate for this measure was 72.05%, which was above goal, and greater than 4 percentage points above both regional (67.63%) and national (67.05%) averages.

  2. Childhood Immunizations:

    The HEDIS rate for childhood immunizations improved from a baseline of 20.18% in 2008 to 45.55% in 2010. The 2010 rate is also above the regional average (42.38%) and BCBSNC ranks second in the five PPO plans in NC for this measure.

  3. Colon Cancer Screenings:

    The BCBSNC rate for this measure improved from a baseline of 47.69% in 2009 to 50.26% in 2010, which is 2 percentage points above goal, and above both the regional (50.14%) and national (47.03%) averages.

  4. Flu Shot Campaign:

    The 2010 PPO flu vaccine rates among members 50 and over was at 51.78%, which is three percentage points higher than 2009. BCBSNC was also above the regional (50.59%) and national (50.46%) averages.

  5. Mental Health Hospitalization Follow-Ups:

    In 2010 BCBSNC tracked two mental health hospitalization follow-up measures: 7 days (45.54%) and 30 days (68.59%). Both measures exceeded their baseline goals by nine percentage points.

  6. Comprehensive Diabetic Eye Care:

    In 2010, BCBSNC scored 44.53% for comprehensive eye exams, which is an increase of nine percentage points over the 2009 score. The 2010 rate is also higher than the Regional (41.33%) and National (42.60%) averages. Additionally, the Plan’s rate for the HbA1c was 85.64% in 2010, which was a seven percentage point increase over 2009.

  7. Customer Service Enrollment and Claims Operational Performance:

    Year-end cumulative performance for each CGO operational performance measure exceeded goals. Additionally, the 2010 CAHPS results show BCBSNC ranks first in the five PPO plans in NC for this measure for accuracy of PPO claims handling.

  8. Bridges to Excellence for ASO Programs:

    In 2010, BCBSNC rewarded physicians for 459 recognitions with a total of $118,895 in rewards payments. While reward payments were not as significant for physicians because only a small number of ASO groups participated (approximately two), it is expected that the plan gained similar results to the BTE pilot. The results include: fewer specialist and ER visits, lower high cost radiology, and lower average length of stay.

  9. Blue Quality Physician Program:

    Achieving Blue Quality Physician Program recognition requires considerable effort on the part of the practice. The first practice received recognition in February of 2011. By the end of December, 29 practices with 140 physicians were recognized in the BQPP program. The Quality Based Network staff continues to promote the program among the eligible practices in the state.

  10. Provider Performance Analytics:

    The MedVantage Health Smart Designer software was installed and the Provider Performance Analytic reports were run comparing primary care and cardiology against their peers on 22 nationally recognized quality measures that focus on preventive care, cardiac services, heart failure and diabetes. Reports will be distributed to physicians in early 2011.

  11. Blue Distinction Centers:

    Two new Blue Distinction Center programs, Spine Surgery (10 facilities) and Knee and Hip Replacement (16 facilities) were implemented in January of 2010. In addition, BCBSNC participated as a pilot plan researching the concept of a “System of Care” for common cancer care with the Blue Cross Blue Shield Association and seven hospitals. This new view of Blue Distinction Centers is needed because various types of providers, locations, and services are often involved in the treatment of cancer patients. Further work on this concept is expected in 2011.