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Quality Improvement Program Information Available to Providers

March 12, 2019

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 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.

Quality Improvement Program includes many activities to 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 health plan.

Information regarding the Quality Improvement Program is available in the BCBSTX provider manuals. These manuals are available online on the provider website 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.