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32 11/2005
Preventive Health & Clinical Practice Guidelines
To support these programs and members’ preventive health benefits, BCBSHP
adopted nationally recognized standards of care/guidelines for preventive health and
clinical practice. These guidelines are provided in the Provider section of our Web site
www.bcbsga.com under Medical Management or you can call (404) 848-2122 to
request a copy. As a network provider, notice of guideline revisions as well new
guidelines are published in the
Provider Communicator
as they are
developed/adopted by BCBSHP.
Periodically, you will receive guideline status reports as elements of the provider
profile. These reports are intended to provide you with information regarding your
patient panel specific to key guideline indicators. Our goal is to provide you with
current information and support guideline compliance through our programs.
Quality Management and Improvement
The BCBSGa/BCBSHP Quality Management program is comprehensive in its scope and
activities. BCBSGa/BCBSHP requires all hospitals, physicians, facilities and other
health care professionals to cooperate with quality management and improvement
initiatives, and this is negotiated in contracts. BCBSGa/BCBSHP welcomes the
opportunity to collaborate with hospitals on projects/initiatives of mutual interest.
Hospitals should send a discharge summary to the PCP caring for any hospitalized
BCBSGa/BCBSHP member. The PCP is identified on each HMO/POS member’s
insurance card. By sharing information about recent hospitalization, the PCP is
afforded the opportunity to manage the patient with full knowledge of changes in the
patient’s health status.
Patient Safety
Leapfrog Group
Patient safety is an important issue to BCBSGa/BCBSHP and to regulators, accrediting
agencies, and purchasers of health care. The 1999 report from the Institute of
Medicine noted that up to 98,000 Americans die each year from preventable mistakes
that occur during hospitalization. In the aftermath of the report, the Leapfrog Group,
a coalition of more than 90 public and private organizations that provide health care,
took steps to reduce hospital errors. The group is promoting three processes that