Quality Assurance
At Blue Cross Blue Shield of Massachusetts, your health is our top priority. To ensure the care you receive meets the highest possible standards, we've undertaken several quality initiatives.
Our Quality Initiatives
Medication Therapy Management
Disease Management
Our Quality Initiatives
Massachusetts eHealth Collaborative
Beginning in 2004, we provided $50 million to help fund the Massachusetts eHealth Collaborative, which is a statewide program that will focus on developing an electronic health record system. Electronic medical records help provide complete, readily available medical information and have been shown to improve the quality of care provided to patients. In addition to electronic medical records, the Massachusetts eHealth Collaborative will focus on offering health care providers electronic decision-support tools. This initiative is being developed with the help of 35 health care organizations throughout Massachusetts.
Primary Care Incentives and Hospital Quality Improvement
Our Primary Care Physician Incentive Plan and Hospital Quality Improvement Plan allow both providers and hospitals to participate in an incentive program that rewards them for meeting certain nationally recognized quality standards and patient safety goals. Physicians must choose to participate in this program, and you can check to see if your physician group participates by using our Find A Doctor feature.
Institute for Healthcare Improvement
In 2004, we pledged $3 million to the Institute for Healthcare Improvement (IHI), an internationally recognized not-for-profit organization based in Massachusetts. The IHI will use funding to support its national patient safety campaign and will also apply $2.5 million of the total grant toward supporting Massachusetts hospitals conducting quality and patient safety improvement projects.
Medication Therapy Management
To help ensure that the quantity and dosage of your medications remain consistent with manufacturer, clinical, and FDA recommendations, we maintain a list of medications subject to Quality Care Dosing (QCD). When you fill a prescription for a medication subject to QCD, your prescription is reviewed for:
Dose Consolidation
Dose Consolidation checks to see whether you're taking two or more daily doses of medicine that could be replaced with one daily dose providing the same total amount of medication. Dose Consolidation advantages include: making it more convenient for you to take your medication (you take fewer pills, instead of several doses or pills daily); and helping control overall pharmacy costs.
Recommended Monthly Dosing Level
This process checks to see that your monthly dosage of medication is consistent with both the manufacturer's and the FDA's monthly dosing recommendations and clinical information. Your doctor can also apply for an exception to QCD guidelines when medically necessary.
Additional prescription safety and quality measures include:
Express Scripts, Inc., Medication Alert
Express Scripts, Inc. is the prescription mail order service provider for our Medicare Advantage and Medex plans with prescription coverage. When you fill a mail order prescription, Express Scripts, Inc. will electronically review it against your previous or current prescriptions. If safety issues are detected, Express Scripts will send an alert to the retail or mail-order pharmacy filling your prescriptions.
