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. The quality performance is measured by a combination of self-reported and claims-based quality measures.

Self-reported Quality Measures

A patient-centered medical home model requires practice transformation.

Recognizing that fact, the first set of BlueAlliance measures (indicated by  the inner circle) allows participating organizations to report on and be rewarded for their quality efforts. The measures gauge the steps an organization is taking to provide:

  • Team-based Care
  • Primary Care Access
  • Care Coordination & Transitions
  • Behavioral Health
  • Patient Engagement & Experience
  • Quality Improvement

 

Claims-based Quality Measures

As a participating organization transforms to the medical home model, patient care—and therefore quality outcomes—will reflect the changes.

Claims-based quality measures (indicated by the darker blue shapes of the outer circle) assess the results of an organization’s quality efforts in the following categories:

  • Potentially Preventable ER Visits
  • Potentially Preventable Admissions
  • Well Child Visits—First 15 Months
  • Well Child Visits—3-6 Years
  • Breast Cancer Screenings