Blue Cross & Blue Shield of Rhode Island earns “Excellent” accreditation status from the National Committee for Quality Assurance


PROVIDENCE, RI — Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced that its commercial preferred provider organization (PPO) was awarded an “Excellent” accreditation status by the National Committee for Quality Assurance (NCQA) for its exceptional service and clinical quality. Additionally, BCBSRI was rated 4.5 out of 5 in NCQA’s Private Health Insurance Ratings 2017-2018 making it the top-rated PPO plan in Rhode Island, and one of the highest-rated health insurance plans in the nation.

BCBSRI’s 4.5 commercial PPO product line score based on NCQA’s Health Insurance Plan Ratings 2017-2018 places the company in the top 4 percent nationally of the 235 PPO plans rated. Only 10 PPO plans in the country received a score of 4.5 or above.

“This accreditation comes as the result of our ongoing efforts to collaborate with the local provider community to ensure Rhode Islanders receive care that is both high-quality and effective,” said Gus Manocchia, M.D., BCBSRI senior vice president and chief medical officer. “Working with provider partners, we are determined to introduce innovations that meet the needs of our members in an evolving healthcare landscape. We hold ourselves to the highest standards of quality for all of our current and future products and services.”

BCBSRI embarked on multiple quality initiatives in 2016 in collaboration with its network of primary care providers to strive toward providing the highest level of service to members, including:
• Continued investment in BCBSRI’s value-based primary care provider quality incentive program (PQIP). The program highlights a partnership between BCBSRI and providers to work together to close gaps in care and meet several quality measures. Those measures are mainly centered around preventive health screenings for high-risk diseases such as cancer and diabetes.
• BCBSRI administered a series of reminder card campaigns focused on educating members on the importance of childhood immunizations, colorectal cancer screenings, cervical cancer screenings, breast cancer screenings and diabetes screenings (eye exam, nephropathy and A1C test). Members who had not followed up on these services were encouraged to see their providers and BCBSRI offered resources to connect them with care. 
• BCBSRI embedded nurse case managers and pharmacists into its systems of care with a goal of creating a better member experience as well as better health outcomes.

NCQA accredits and certifies a wide range of health care 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. HEDIS is designed to ensure that purchasers and consumers have the information they need to reliably compare health care 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.

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