New radiology-focused initiative aims to improve quality of care and patient outcomes

Blue Cross Blue Shield of Michigan and Blue Care Network are engaging Covera Health to launch a radiology-focused quality improvement program to help us better support radiologists and referring providers in their efforts to improve diagnostic quality, overall care and patient outcomes.

Covera’s quality improvement programs support radiology facilities and radiologists in their efforts to:

• Engage in continuous quality improvement. 
• Identify peer-learning opportunities.
• Improve quality of care provided to members.
• Improve patient outcomes.

Participating practices and radiologists will:

• Have access to Covera’s Diagnostic Intelligence Platform, which includes quality assurance tools that incorporate clinically validated artificial intelligence and data science.
• Have access to confidential quality assurance analytics and quality insights, including study-level, provider-level and practice-level reporting. This includes actionable insights to target clinical areas where additional peer learning and educational activities may be beneficial.
• Be eligible for a high-quality designation. This designation makes it easier for referring providers to refer patients to high-quality radiology centers, which will help to improve member outcomes.

Program participation and quality assurance insights

• Participation in this program will be voluntary and will be available to all radiology providers and facilities. Neither reimbursement nor value-based arrangements will be affected if a practice or radiologist chooses not to participate in Covera’s quality improvement program.
• To participate in the program, practices must apply and complete participation agreements with Covera.
• As part of its certification by the Agency for Healthcare Research and Quality as a patient safety organization, Covera can’t share sensitive provider data with other parties, including Blue Cross and BCN. This includes data related to quality assurance analytics and insights.

Program availability

Starting in April 2023, the program will be available for the following groups and members:

• BCN commercial — Members who have coverage through fully insured groups and members who have individual coverage
• BCN Advantage℠ — All groups and all members who have individual coverage
• Blue Cross commercial — Members who have coverage through fully insured groups and members who have individual coverage
• Medicare Plus Blue℠ — All groups and all members who have individual coverage

Designations for quality and value

On prior authorization requests approved by AIM Specialty Health^®, Covera designations will display as follows:

• For BCN commercial, BCN Advantage and Medicare Plus Blue members, facilities will be identified as having high-quality designations and will be listed as recommended providers.
• For Blue Cross commercial, facilities will be identified as having high-quality designations.

Providers that are designated as high quality and are also cost effective will receive an additional “high-value” designation on prior authorization requests approved by AIM. Cost efficiency is determined through cost factors including (but not limited to):

• The cost of the diagnostic service being requested
• The average cost of the service in the geographic area

Only radiology centers that have been designated as high-quality are eligible to receive the high-value designation.

Register for webinars to learn more

Blue Cross, BCN and Covera Health will host webinars throughout the program, starting in January 2023. The webinars will provide an overview of the Covera programs, how they improved outcomes for members and providers, and how they can enhance peer learning opportunities.

For more information on dates and clinical areas covered, go to coverahealth.com/webinar.**

Questions?

If you have questions about this program, contact Covera Health by calling 1-855-211-2272 or by sending an email message to bcbsmsupport@coverahealth.com.

Our commitment to quality

Blue Cross and BCN are proud to be leaders in advancing collaborative partnerships with our provider community to improve the quality, outcomes and value of care delivered to our members. This new radiology-focused initiative represents a significant step in fulfilling our commitment to our providers, our members and the communities we serve.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

AIM Specialty Health is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our ereferrals.bcbsm.com website.

Covera Health is an independent company that supports Blue Cross Blue Shield of Michigan and Blue Care Network by providing programs to help improve the diagnostic quality, quality of care and member outcomes related to radiology.