Our Medicaid Quality Improvement Program

January 13, 2020

The principle goal of the Blue Cross and Blue Shield of New Mexico (BCBSNM) Medicaid Quality Improvement (QI) Program is to improve our members' health. We strive to help them understand the importance of taking better care of themselves and their families. Every year, we develop a quality improvement plan in which we set specific quality goals, identifying the activities we will implement to achieve them and defining how we will measure our progress. All activities and goals lead back to the primary goal: improved health for our members, your patients.

The QI Program is a team effort that is built on contributions from our BCBSNM peers across all lines of business, departments and divisions. Program goals for health care and services are developed with input from you and from our members, brought into focus by our leadership, and implemented by staff dedicated to the needs of our Medicaid membership. Quality committees, chaired by medical directors, keep our projects on target and focused through policies and procedures for day-to-day operations and annual measurements like HEDIS and CAHPS.

We continuously evaluate the effectiveness of our QI Program by measuring our success in terms of nationally applied and internally established standards and benchmarks. We are proud to have met most of our goals in 2019 and are especially pleased to report that we maintained National Committee for Quality Assurance (NCQA) accreditation for each of our product lines, including Medicaid.

Several key points in the evaluation of our 2019 QI Program included:

  • Member complaints and appeals
  • Provider and practitioner safety and care practices
  • Clinical practice guidelines
  • Member and provider experience
  • Clinical performance data
  • Health care utilization and complex disease management

BCBSNM met the following 2019 QI Program achievements and goals:

  • Achieved regional percentile benchmarks for select New Mexico Human Services Department (HSD) performance measures
  • Achieved Full Compliance with New Mexico External Quality Review Organization standards for annual audit of QI Performance Measure Program quality initiatives, interventions and process improvement projects
  • Steadily improved compliance with HSD requirements for Critical Incidents processing and reporting; met and exceeded internal and external goals for timeliness and accuracy
  • Exceeded audit requirements of the HEDIS annual medical records abstraction project
  • Improved NCQA Accreditation to "Commendable" rating

To learn more about the 2019 QI Program evaluation and providers' contributions to our QI efforts, please email or call the QI Department at 855-699-0042.

HEDIS is a registered trademark of the National Committee for Quality Assurance.

CAHPS is a registered trademark of the Agency for Healthcare Research and Quality.