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Provider quality measurement

Fundamentally, BlueAlliance helps health care organizations transition:

From:

The current industry standard fragmented care model and fee-for-service payments

To:

Coordinated, effective and quality care by implementing a patient-centered medical home model.

The higher the quality performance, the higher the monetary rewards.

Quality Measures

The following measures are used for assessing quality of BlueAlliance providers. Each measure is worth a maximum number of points. Percentage of points earned determines the provider organization's quality tier for purposes of BlueAlliance payments.

Graphical depiction of the 100 points of the BlueAllicance Claims-Based measure for 2022 Annual Attestation, based on outcomes and cost, Starting with better outcomes on top and lower cost on the bottom, moving around the image to the right as follows; 20 points for potentially preventable ER Visits, 20 points for potentially preventable admissions, 10 points for post-discharge follow-up visitis, 10 points for primary care visits, 10 points for well child visists 15-30 months, 15 points for Well Child Visits 0-15 months, 15 points for breast cancer screening