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29 11/2005
Quality Improvement
QI Program Description
The BCBSGa/BCBSHP Quality Improvement program (Program) is an ongoing,
comprehensive, and integrated system designed to actively initiate, monitor, evaluate
and promote standards of health care practice and infrastructures essential to the
delivery of clinical care and service to members. The goals of the program are:
• To develop and maintain a well-integrated system to continuously identify,
measure, assess and improve quality outcomes through standardized and
collaborative activities.
• To respond to the needs and expectation of BCBSGa/BCBSHP’s internal and
external customers by evaluating performance relative to meeting those needs and
expectations.
• To maintain compliance with regulatory requirements and accreditation standards.
• To promote processes that reduces medical errors and improves patient safety.
• To promote high quality of care and service and effective utilization of service to
all members.
• To identify the educational needs of members, practitioners and other health care
professionals including behavioral health practitioners and providers.
• To protect member identifiable health information of all members by ensuring
their protected health information (PHI) is released in accordance with federal,
state and all other pertinent regulatory requirements.
• To promote collaborative activities among other insurers, employers groups,
providers, including behavioral health providers and practitioners.
The BCBSHP Board of Directors evaluates the effectiveness of and approves the
Program on an annual basis. The Board of Directors has further delegated
responsibility for the development, implementation and evaluation of the Program to
the Physician Relations Council and the BCBSHP Quality Management Committee
(QMC). The QMC and its sub-committees are charged with monitoring and evaluating
the results of quality initiatives and initiating change when results are less than
desired or when areas for improvement are identified.