Quality Management Member Outreach for Closing Care Gaps

Member outreach has become a vital tool for helping to achieve member engagement and improving healthcare compliance throughout the year. Member Outreach provides an opportunity to educate and engage with our Blue Cross and Blue Shield of Texas (BCBSTX) members to discuss free health screenings, facilitate access to services and allow us the opportunity to listen to our member’s needs.

Health outreach programs activities play a critical role in improving and extending the reach of health care.

We want to share our efforts during the last year to close patient gaps in care and assure our members are receiving the high-quality care that each deserves.

The Quality Improvement team rallied last year and began an internal outreach program to several members with various health conditions and get these members needed health screenings. For instance, Quality Management was able to reach and educate women on importance of a Well Women Exam and mammogram and when each member should have them.

Well Women exams and mammograms were two focused measures for last year’s Quality Outreach Program. A BCBSTX Quality Management Specialist (QMS) engaged with a member over age 65 years who never had a mammogram.  The QMS provided the member with evidenced- based information about mammograms, addressed her concerns, and assisted with scheduling the exam and transportation. Then followed up with her to be sure she had completed the screening.

Stories like these are what make Member Outreach such a fulfilling task. Outreach allows providers and BCBSTX to help our members with their healthcare needs and to get feedback on where to improve.

While BCBSTX has made strides, we have found providers have better success when they perform the outreach. We are available to help our providers set up their preventive care outreach programs. For more information, please contact Lori Novicki, Clinical Practice Consultant, at Lori_Novicki@bcbstx.com.

Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps THSteps for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.