BlueCross BlueShield of Tennessee has earned recognition for its commercial and BlueCare Tennessee plans from the National Committee for Quality Assurance (NCQA). BlueCare earned a 3.5-star quality rating. The commercial plan earned 4 stars, the only commercial plan in the state of Tennessee with this rating.
"At BlueCross, we do our best each day to improve the physical and mental health of our members," said Dr. Andrea Willis, SVP and chief medical officer at BlueCross. "We support the NCQA's commitment to helping consumers and employers make more informed health care choices. Earning such high marks through their performance-measurement tools demonstrates the value we bring as a trusted partner in health."
NCQA star ratings are determined by two data components: the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey of health care consumers, and the Healthcare Effectiveness Data and Information Set (HEDIS), which measures clinical performance and health outcomes.
CAHPS collects direct feedback from health care consumers and measures how they perceive the care they receive from providers and their perception of the services that health insurers provide that support their care. This includes key aspects like overall rating of health plan, coordination of care, claims processing and customer service.
HEDIS determines whether consumers use their health benefits and have completed their recommended care and screenings, and whether that in turn has resulted in improved overall health outcomes. Nearly 40 measures in total are evaluated for commercial plans, including significant public health issues like:
In 2020, BlueCross worked with its provider partners to make telehealth more widely available. This meant members could more conveniently and comfortably have their health care needs met and close their gaps in care, because factors such as blood pressure monitoring, medication adherence, and behavioral health therapy/consultations ? all HEDIS measures ? could be managed using virtual visits. These efforts aligned with the NCQA's allowing of telehealth results to factor into its 2021 ratings.
"Our mission is peace of mind through better health for our members, and these scores are proof of that commitment," added Wisterya Thompson, director of Clinical Care and Quality Improvement at BlueCross. "Even during a global pandemic, we've been able to educate and empower our members to utilize telehealth resources, complete preventive health screenings and get the care they need in a timely fashion."
BlueCross commercial plans include employer-based and Individual/Marketplace coverage. BlueCare Tennessee is a BlueCross subsidiary serving TennCare members.
NCQA is a private, nonprofit organization dedicated to improving health care quality. It accredits and certifies a wide range of organizations and is the only program in the industry that generates its rankings from clinical performance and consumer experience data.
BlueCross BlueShield of Tennessee is a taxpaying, not-for-profit health plan serving more than 3.4 million members in Tennessee and around the country. The Chattanooga-based company was founded in 1945 and has brought peace of mind to its members and local communities for more than 75 years. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company's news center at bcbstnews.com.