Awards salute Medicare Advantage providers for their star-ratings support

We recently honored more than 200 Medicare Advantage providers with Provider Distinction Awards. These awards recognize the outstanding contributions providers have made to the BCN Advantage^SM and Blue Cross Medicare Plus Blue^SM PPO plans’ 2016 star ratings.

This is the fourth year we’ve recognized Medicare Advantage providers for their contributions to our star quality measures. Our relationship with providers is crucial to our star ratings success.

The Centers for Medicare & Medicaid Services measures the quality to drive improvements in accountability with the health care plans, doctors and hospitals. This rating system applies to all Medicare Advantage lines of business. The star rating includes 44 metrics that span five broad categories:

• Outcomes
• Intermediate outcomes
• Patient experience
• Access
• Process

The award criteria include the following measures that support the star ratings for BCN Advantage^SM and Blue Cross Medicare Plus Blue^SM:

• Achieving 83 percent or higher for joint contracts on the measures below
• Or 85 percent or higher for single contracts on the measures below

The measures are:

• Outcomes (Staying healthy)
• Breast cancer screening
• Colorectal cancer screening
• Intermediate outcomes (managing long-term conditions)
• Diabetes measurements
• Eye
• Kidney
• Blood sugar control

Providers must have a minimum of five services that count toward the star rating (for example, a diabetes test or colorectal screening). The number of services completed divided by the number of eligible services equals the quality score.

Please note:

• Providers must be currently credentialed and contracted with Blue Cross Medicare Plus Blue PPO or BCN Advantage, and in good standing.
• Providers may not be in the low quality score rating program. (Providers with low quality scores will be eligible for future awards once they’ve completed the Quality Rating System program.)

The Provider Distinction Awards plaque is perpetual; we add stars to it as the physician groups continue to achieve impressive scores. The providers who received plaques also receive gifts for their office staff who handled the administrative work. We appreciate their support.