Quality Improvement Program Information Available to Providers

February 8, 2018

Blue Cross and Blue Shield of Texas (BCBSTX) has a Quality Improvement Program to better serve our members. The program focuses on preventive health, behavioral health, patient safety, and condition management. By collaborating with physicians, providers and health care professionals, the quality improvement programs help promote safe and appropriate care. It also encourages the efficient use of resources, which ultimately helps reduce health care costs and improves member satisfaction with their health plan.

The Quality Improvement Program includes many activities which develop, review, and monitor services provided including but not limited to:

  • Member complaints and appeals,
  • Member and provider satisfaction,
  • Utilization management statistics and systematic measurement of clinical care (e.g., such as cancer screenings), immunizations and chronic conditions (e.g., asthma and diabetes)

Member care and service are evaluated on a regular basis to determine whether members are receiving appropriate care and service and that they are satisfied with the BCBSTX health plan.

Information regarding the Quality Improvement Program is available in the provider manuals. These manuals are available online at under Standards and Requirements. To receive a written summary of the Quality Improvement Program, which includes outcomes, please call the Quality Improvement Programs Department at 800-863-9798.