Goal
The Blue Cross and Blue Shield of New Mexico Quality Improvement Program’s primary goal is to improve our members’ health status and outcomes by deploying meaningful quality improvement activities and interventions. These efforts are implemented across all care settings with the aim to improve the quality of care and services delivered to our members, your patients.
Scope
The Quality Improvement/Quality Management Program encompasses clinical care and services that are furnished to our members, inclusive of medical, behavioral, and long-term care services, ancillary services, pharmacy services, dental, transportation and vendor services, member services, member experience, patient (member) safety and the efficient use of resources and adequacy of those resources.
The QI/QM program strategy is comprehensive and includes cross-departmental mechanisms to identify, monitor and evaluate intervention outcome effectiveness, that impacts the safety, accessibility, availability, continuity and quality of care and services provided to our members. BCBSNM is committed to the delivery of high quality medical, behavioral, and long-term care regardless of our members ethnicity, cultural and/or religious beliefs or language.
BCBSNM continuously evaluates the effectiveness of the QI/QM Program by measuring improvements against internal, state and nationally established standards and benchmarks. In 2023, BCBSNM met most its quality goals and improved to a three-star rating on our accreditation through the National Committee for Quality Assurance for our Medicaid line of business.
Several key points in the evaluation of our 2023 QI Program included:
- Member complaints and appeals
- Continuity of Medical and Behavioral Care
- Healthcare Effectiveness Data and Information Set HEDIS®
- Consumer Assessment of Healthcare Providers and Systems CAHPS Survey data
- Provider and practitioner safety and care practices
- Clinical practice guidelines
- Clinical quality initiatives
- Member and provider experience
- Clinical performance data
- Health care utilization and complex disease management
BCBSNM met the following 2023 QI Program achievements and goals:
- Met or exceeded seven out of ten established targets for selected New Mexico Human Services Department performance measures for measurement year 2022 that was reported in 2023
- Achieved full-compliance with our External Quality Review Organization standards annual audit for our QI Performance Measures Program that included review of all quality initiatives, interventions, and deployed performance improvement projects
- Improved to a Three-Star Health Plan Rating through NCQA and successfully renewed accreditation for another three-year cycle
- Obtained NCQA LTSS distinction for our Medicaid Line of Business
- Achieved Health Equity Accreditation through NCQA for Medicaid line of business
- Steadily improved compliance with HSD requirements for Critical Incidents processing and reporting; met and exceeded internal and external goals for timeliness and accuracy
- Met audit requirements for our annual HEDIS® medical records abstraction project
Participation in QI/QM
As a contracted provider in the Blue Cross Community Centennial network providers and practitioners are required to cooperate with all Quality Improvement activities, as well as allow the use of provider and/or practitioner performance data to ensure the success of the QI/QM Program. If you are interested in learning more about Blue Cross Community Centennial QI/QM Program or to request a printed copy, please email qualityinquiry@bcbsnm.com.
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.