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Home / News & IndustryManaged Care Insight and Analysis
Updated: December 14, 2010
Tennessee Health Plan Develops New Quality Measures

Screenings for childhood immunizations and monitoring of cardiovascular conditions have been added to BlueCross BlueShield of Tennessee’s existing online suite of eight preventive quality measures that are used in assessing the quality of care members receive from their doctors.

The new measures are designed to help prevent diseases such as measles, mumps and rubella, and to better manage coronary artery/heart disease, the health plan said. According to Dr. Tom Lundquist, vice president of performance measures and improvement for the health plan, the measures were selected by BlueCross, and reviewed by an advisory panel of physicians, based on their ability to reach crucial segments of the population and positively impact their health status.

"These newest additions to our physician quality and cost tool help expand the available information that our members can access in making important decisions about their healthcare," said Lundquist.

Lundquist noted that as recently as 2009, the U.S. experienced an outbreak of measles, a highly-contagious disease that has been technically eradicated in America for nearly a decade. "In selecting the immunizations as a quality measure, we realized that the healthcare community must remain vigilant in ensuring children receive the proper vaccinations to stop these preventable diseases," he added.

The immunization quality indicator pulls information from the State of Tennessee’s immunization registry and supplements BlueCross’ externally-validated claims data which is used to assess physician quality.

Statewide Physicians Panel Helps Collaboration

Each quality measure contains symbols to indicate whether a doctor is above or below the specialty average for a specific measure, officials said.

The BlueCross Physician Quality and Cost Transparency program rolled out in the fall of 2008. Working in close collaboration with a statewide physician panel and other parties, such as state anTennessee Health Plan Develops New Quality Measuresdcounty medical associations, BlueCross initially identified and introduced eight preventive quality measures:

  • chlamydia screening for women;
  • colorectal cancer screenings;
  • mammography;
  • cervical cancer screening;
  • HBA1C testing for diabetes;
  • LDL monitoring for diabetes, monitoring for diabetic nephropathy; and
  • diabetic retinal exams.

Since the program launch, the physician quality and cost tool has been visited nearly 50,000 times by BlueCross members seeking data on the quality and cost of the medical treatments and services they receive from their doctors.

"It’s our hope that as we increase the number of quality measurements in conjunction with cost data, that more of our members will take advantage of this effective consumer tool," Lundquist stated. "And that their increased awareness and engagement will lead them to better health and lower future costs."

Address: Blue Cross Blue Shield of Tennessee, P.O Box 182277, Chattanooga, TN 37422-7277;

  This article was taken from:
The Executive Report on Managed Care

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