We’re pleased to share the news that the National Committee for Quality Assurance (NCQA) has awarded Blue Cross & Blue Shield of Rhode Island (BCBSRI) Preferred Provider Organization (PPO) product lines “Excellent” accreditation status for BCBSRI’s exceptional service and clinical quality. NCQA also rated BCBSRI PPO products 4.5 out of 5 as a part of the Private Health Insurance Plan Ratings 2018-2019.

BCBSRI’s 4.5 commercial Preferred Provider Organization (PPO) product line places the company in the top 4 percent nationally of the 272 PPO plans rated. Only 13 PPO plans in the country received a score of 4.5 or above.

BCBSRI embarked on multiple quality initiatives in 2018 in collaboration with its network of primary care providers to elevate efforts to provide members with high-quality care. Some of those initiatives included:

• Full time on-site nurse case managers at each of BCBSRI’s Your Blue Store locations. Members can speak to a nurse to assess their wellness needs, medications, primary care providers and help find ways to better manage their health conditions.
• Continued investment in BCBSRI’s value-based primary care provider quality incentive program (PQIP). This program highlights a partnership between BCBSRI and providers to work together to close gaps in care and meet quality measures. Those measures are mainly centered around preventive health screenings for high-risk diseases such as cancer and diabetes.
• Introduction of the Patient I Wants© program created by Help Me Health, LLC, to introduce providers and their staff to innovative tactics for fostering and supporting a patient-centric culture change.

NCQA accredits and certifies a wide range of healthcare organizations and manages the evolution of HEDIS® (Health Care Effectiveness Data and Information Set), the performance measurement tool used by more than 90 percent of the nation’s health plans.

“Accreditation is a key differentiator when it comes to understanding a health plan’s focus on quality,” said Karen Stenhouse, BCBSRI accreditation manager. “We are pleased to see our hard work recognized, not only because it affirms the great work we’ve been doing, but also because it incents us to do more to enhance the experience of our members and the provider community.”

HEDIS is designed to ensure that purchasers and consumers have the information they need to reliably compare healthcare quality. BCBSRI’s rating signals that the service and clinical quality of BCBSRI’s commercial PPO has met NCQA’s highest standards for consumer protection and quality improvement.