Ensuring quality
Blue Care Network's vision is to partner with you, your employees and our physicians to maintain, improve and optimize our members' health. Our partnership with you means not only providing quality care for your employees, but doing so cost effectively.
Blue Care Network does it better
Excellence
BCN's success in producing good health outcomes and matching people's health care needs with the right set of resources is measurable. We've received Excellent accreditation from the National Committee for Quality Assurance since 2000. This is the highest level of accreditation awarded by NCQA, a nationally recognized organization that measures the quality of America's health care and health plans.
Program Depth
BCN provides a continuum of health care. We offer programs for preventive care (to keep people healthy), programs for health maintenance and disease management (to keep people with chronic conditions functioning at the highest level possible) and care management programs (to help people with complicated illnesses and injuries get the care they need, when they need it).
In addition, our innovative pharmacy programs provide state-of-the-art pharmaceutical treatment with safeguards and interventions to protect members from drug interactions and side effects. Managing care well not only improves the health and quality of life for our members, it means medical care is more cost effective. Members don't receive inappropriate, ineffective or harmful treatments and, since they're sick less often, they need less care overall.
Cost Control
When it comes to health care costs, the right level of care is essential.
- Some people need less care: We help manage chronic conditions so members have fewer acute episodes that result in emergency room visits and hospitalizations.
- Some people need more care: We remind them to get needed services and encourage them to use their preventive health benefits.
The right care at the right time, high-quality care and effective use of clinical resources are just some of the ways we look after our members and how we promote and help arrange health care at the best possible price.
Better choices, better outcomes
Data to dollars
As we've increased the rate of members who get important screens, tests and treatments, we've helped them maximize their health and made sure health resources are used most effectively.
Consider these indicators of how better care drives lower costs:
- Almost all — 93 percent — of pregnant BCN members see their doctor during the first trimester.
- Every dollar spent on prenatal care results in expected savings of $3.33 for postnatal care and $4.63 for long-term morbidity costs.*
- Treating a heart failure patient with beta-blockers reduces total direct costs almost $4,000 over a five-year period due to reduced hospitalization.**
- 100 percent of BCN members receive beta-blocker treatment after a heart attack as measured by HEDIS.***
- All members with diabetes are automatically enrolled in our disease management programs and are regularly reminded to work with their doctors to get the tests they need and to monitor their condition.
- Patients who receive active diabetes treatment attain a more productive work capacity, higher employment retention, less absenteeism and a more positive outlook.*
- Cost of treating an influenza-like illness is estimated at $145 per case. The estimated cost of an influenza vaccine is $16.70 per person.
- BCN covers flu shots and reminds members to get them through our newsletter, disease management materials and special mailings.
Generic drugs chosen more often
Through member and physician education and unique benefit designs, we've increased our rate of generic drug usage. Generic drugs offer members safe and effective treatment at much less cost than brand-name drugs. More than half of the medications prescribed for our members are generics. To learn more, visit Brand-Name vs. Generic Drugs.
Monitoring member care
We monitor members' hospital admissions, surgeries and physician office visits to detect overuse of services — a waste of resources — and under use — members not getting needed care. We also review some requested medical care before it's administered, especially emerging technologies, unusual medical treatments and potentially experimental regimens, to ensure patients receive proven and evidence-based treatments.
Pharmacy creates independent formulary
Rather than rely on a benefit management company to get discounts for certain brand-name drugs, BCN works independently to identify the lowest net cost for specific types of therapy. This has helped to significantly lower drug costs without compromising patient care or safety and has given us more accurate drug cost information. To learn more, visit Pharmacy Services.
Return on investment
Our BlueHealthConnection programs invest in our members' health. Doing the right thing for members — helping them get the care they need in the most appropriate setting — is also a prudent use of resources. The resources we invest in these programs result in members having fewer costly hospital stays and emergency room visits. To learn more, visit Managing Member Health.
Success! The value of what didn't happen.
Our members with chronic conditions, such as asthma, congestive heart failure and diabetes, are having, on average, fewer hospital stays. By helping members understand and control their medical conditions and encouraging them to partner with their primary care physicians, we're giving them gifts of incalculable value — time to attend to their regular duties and better health. With the cost of prescription drugs, hospital stays and other medical expenses climbing, the economic impact is also significant.
* Source: National Committee for Quality Assurance
** Source: The State of Health Care Quality 2005, National Committee for Quality Assurance
*** HEDIS ® (Health Plan Employer Data and Information Set) is a registered trademark of the National Committee for Quality Assurance
page modified 09/23/2011