2009 Blue Star^SM Medical Group/IPA Report with Blue Ribbon^SM Results Available
The Blue Star Medical Group/IPA Report recognizes HMO contracting medical groups/Independent Practice Associations (IPAs) that have documented high levels of performance in providing patient care. Annually, Blue Cross and Blue Shield of Illinois (BCBSIL) assesses medical group performance based upon national clinical practice and preventive care guidelines. Groups earn a “blue star” each time they meet the target care goal.

Results are publicly reported. HMO members can use the Blue Star Medical Group/IPA Report – along with the Blue Star Hospital Report – to help them choose health care providers that best meet their needs. To make it easy for members to access this information, the Report is available at www.bcbsil.com, is included in the provider directory and is now linked to the online Provider Finder^®. 

Blue Star Performance Measures and Results
The 115 participating medical groups/IPAs earn a “blue star” each time they meet or exceed the target care goal in each of the reporting categories. BCBSIL shares detailed results with the individual medical groups/IPAs to help educate and motivate them to improve their performance in these patient care areas.

The criteria measured performance in: asthma care, diabetes care, mental health follow-up, childhood immunization, breast cancer screening, influenza vaccination, management of cardiovascular conditions, controlling high blood pressure, colorectal cancer screening, and member satisfaction (Blue Ribbon Report).

• 33 groups (29%) received all nine blue stars
• 29 groups (25%) received eight blue stars

View the 2009 Blue Star Medical Group/IPA Report, available online for employer groups, members, providers, and producers at Blue Access^® for Producers. Your group clients can find the report on the employer page, under Resources for Employers.

2009 HEDIS^® and CAHPS^® Reports Measure HMO Care and Service
Each year Blue Cross and Blue Shield of Illinois reports a nationally standardized set of measures related to important areas of care and service, known as HEDIS^® – Health Care Effectiveness Data and Information Set – for HMO Illinois and BlueAdvantage^SM HMO. Developed by the National Committee for Quality Assurance (NCQA), it is one of the most widely used set of health care performance measures in the United States.

The 2009 HEDIS Report summarizes the audited HEDIS results based on 2008 data using HEDIS 2009 specifications. Included are 74 measures across eight domains of care that reflect: effectiveness of care, access/availability of care and use of services. Also, seven measures are being reporting for the first time.

HEDIS Results and Significant Improvements
Of the 37 indicators for which results are comparable to those reported in HEDIS 2008, 14 showed improvement (seven are statistically significant improvements), and 18 were within 1 percentage point of last year’s results.

Significant improvements were realized for:

• Preventive care screenings: breast cancer, colorectal cancer and chlamydia (ages 16-20)
• Testing: children with pharyngitis, and spirometry testing to assess and diagnose chronic obstructive pulmonary disease (COPD)
• Chronic care management: cholesterol control for patients with cardiovascular conditions
• Behavioral health: engagement of treatment for alcohol and other drug dependency

CAHPS Results Measure Member Satisfaction
As part of HEDIS, a survey is sent to a random sample of HMO members. Results of how members feel about their experience with care and service are reported in the CAHPS – Consumer Assessment of Health Plans Survey – Report.

The 2009 CAHPS results are based on care provided in 2008. The following improvements were noted:

• Member satisfaction with the HMOs of BCBSIL trended upward this year and remains several points above national averages.
• The percent of respondents who said their health plan’s customer service ‘always’ gave them the information or help they needed increased significantly from 2008 to 2009.
• Significant multi-year trends show increases in members reporting satisfaction with their personal doctor and satisfaction with claims processing.

View the HEDIS^® and CAHPS^® reports. The reports will be available online shortly.

For information about our HMO Quality Improvement program, call us at (312) 653-3465.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).