TRS-ActiveCare is a self-insured health plan that uses contributions from the state, public schools, and employees to fund health care for participants. Your health care decisions can affect the plan, that's why it's important to use high quality, cost effective services when you can. As a TRS-ActiveCare plan participant, you have access to rich benefits and a broad network of quality providers who will partner with you so you can achieve your best health. Here are some helpful tips for making your plan work for you.
Making the Most of Your Medical Benefits
Here are a few simple things you can do to get the most value out of your benefits.
- Stay in the network. Most health plans have negotiated discounts with doctors, hospitals and other health care experts who are in their network. That often means lower out-of-pocket costs to you.
- Use the ER for emergencies only. Real emergencies call for a trip to the closest emergency room (ER). But you can usually save money on your copayment by going to your primary care doctor for colds, minor sprains and other less serious health issues.
- Take advantage of preventive care. Your plan pays 100% for preventive care screenings. These services can help you avoid health complications.
- Follow your doctor's orders. Be sure to take any medications, treatments or therapies your doctor suggests. That way you can get better quickly and avoid extra costs.
- Use generic drugs. Generic drugs cost less than brand name drugs and offer you the lowest available copay. Generic drugs have the same ingredients and work the same as their brand-name equivalents.
- Use standalone medical service facilities. You can usually lower medical costs by scheduling lab work, imaging and other outpatient services at standalone medical service facilities instead of a full-service or general acute care hospital.
- Know your coverage. Make sure services or treatments are covered before you plan your next doctor's visit. Knowing this ahead of time can save you money.
- Use TRS-Virtual Health for non-urgent care. Through TRS-Virtual Health, you have 24/7 access to care from the comfort of your home.
- Do an "annual check-up" of your health insurance plan. Make sure your plan still meets your needs. This is even more important if you had any major life-changing events in the past year, such as marriage, the birth of a child or the removal of a dependent from your health insurance policy.
Use Your Member Perks
Your plan offers useful tools and conveniences to their members. To get the most out your plan, take full advantage of these perks:
- Get online. We offer a secure website (Blue Access for MembersSM) where you can check the status of claims, view benefits information, find a doctor and much more.
- Learn how to be healthy. We have information to help keep you and your family healthy. Sign up for newsletters, read articles online, or have health and wellness tips.
Use Blue Access for Members
Blue Access for Members is the best way to get the most from your plan. With this secure members-only website, you can:
- Manage your account online
- Take a health assessment to get personalized wellness tips
- Check the status of claims and set-up email alerts
- Order a new ID card and print a temporary card
- Look into our special members-only discounts and offers from health and wellness companies
Log in to Blue Access for Members
Understanding Provider Quality
We offer performance and quality information on doctors, hospitals and other health care facilities to help you make health care choices for you and your family. Be sure to follow your doctor's suggestions about getting care and check whether your benefits cover those services and treatments.
If there is no performance information for a certain doctor or provider that does not mean that the standards of care were not followed. This information might not be there because there is no way to measure it yet, or because there isn't enough data to come up with performance scores.
Provider Quality - Bridges to Excellence Programs
Bridges to Excellence programs recognize and reward top-performing doctors, nurse practitioners and physician assistants who give excellent patient care. These programs, designed and carried out by the Altarum Institute, are based on nationally accepted quality measures that are most predictive of improved patient health. Providers who follow these quality measures often outperform others on process measures of quality. They also have lower average costs per patient and per health episode. Providers who continually improve their practices are rewarded through incentives.
Those recognized by a Bridges to Excellence program:
- Offer a higher measured quality of care than non-recognized providers
- Have fewer episodes per patient and lower resource use per episode
- Have lower average costs per patient and per episode
Bridges to Excellence programs recognize all major chronic conditions and office systems including:
- Asthma
- Cardiac care
- Congestive heart failure
- Cardiology practice
- Chronic obstructive pulmonary disease (COPD)
- Coronary artery disease
- Depression
- Diabetes
- Hypertension
- Inflammatory bowel disease (IBD) care
- Provider office systems
- Spine care
- Medical home
To learn more, visit the Altarum website.
Hospital Quality Measures - Process of Care Measures and Outcome of Care Measures
The Centers for Medicare and Medicaid Services (CMS) follows a standard set of performance measures for recommended hospital care for these 5 conditions:
- Heart attack
- Heart failure
- Pneumonia
- Surgical care improvement and infection prevention
- Pediatric asthma
Hospitals are encouraged to report their quality of care information for these medical conditions. Reporting is voluntary, but it is linked to the payments hospitals get for treating Medicare patients.
Each hospital is given an overall score and detailed benchmark scores for each of the quality measures. The detailed benchmark scores include the national average hospital compliance and the top hospitals' compliance for each of the measures. (The top hospitals are the top 10% of hospitals nationwide.)
Process of care measures include quality measure sets for each of the conditions listed above.
Outcome of care measures are the 30-day mortality (death) and readmission rates for each of these categories:
- Heart attack
- Heart failure
- Pneumonia
Blue Distinction CentersSM
Blue Distinction is a designation awarded to PPO/POS facilities by the Blue Cross and Blue Shield companies to medical facilities that have shown expertise in delivering quality health care. The designation is based on rigorous, evidence-based selection criteria formed by leading medical specialists and professional organizations.
To earn this designation, a facility's overall experience and total data must meet criteria formed by expert clinicians and leading professional organizations.
Blue Distinction Centers+ are hospitals recognized for their expertise and efficiency in delivering specialty care. Quality remains key: to qualify as a Blue Distinction Center+, a facility must first meet all the quality requirements for a Blue Distinction Center before cost will be evaluated.
Learn more about Blue Distinction
Health Care Centers of Excellence
Health Care Center of Excellence is a designation awarded to PPO and HMO facilities that have shown expertise in delivering quality health care. The designation is based on rigorous, evidence-based selection criteria formed by leading medical specialists and professional organizations.
To earn this designation, a facility's overall experience and total data must meet criteria formed by expert clinicians and leading professional organizations.
Health Care Centers of Excellence are hospitals recognized for their expertise and efficiency in delivering specialty care. Quality remains key: to qualify as a Health Care Center of Excellence, a facility must first meet all the quality requirements for a Blue Distinction Center before cost will be evaluated.
BlueCompare for Hospitals
To learn about the care a hospital provides, BlueCompare gets information from the claims hospitals send to external reporting agencies, such as CMS. This data is used to measure and compare hospitals' performance and affordability in providing care.
We measure performance and affordability only for general acute care hospitals--not for specialty hospitals like children's, mental health, or rehabilitation facilities. Hospitals that are given the BlueCompare designation have met or went beyond expected performance and/or affordability measures when compared to other hospitals.
Hospital Consumer Assessment of Healthcare Providers and Systems
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, standardized survey sent to a random sample of hospital patients 18 years and older within 48 hours to 6 weeks after being released from the hospital. The survey includes 10 questions about a patients' view on important measures of care. The HCAHPS results can help you compare patients' experiences among different hospitals and against state and national benchmarks.
The survey includes information about these hospital patient experiences:
- Communications with nurses and doctors
- Responsiveness of hospital staff
- Pain management
- Communication about medicines
- Discharge information
The survey also includes questions about:
- Cleanliness of the hospital
- Quietness of the hospital
- Overall rating of the hospital
- Willingness to recommend the hospital