How We Evaluate Provider Performance

We know our members have a lot to consider when comparing doctors or choosing a provider. To help with this choice, Blue Cross Blue Shield of Michigan and Blue Care Network evaluate provider performance by analyzing data across four health care areas:  

Appropriate medical care

We evaluate how well health care providers follow established best practices to ensure their patients receive the most effective treatment for their unique needs, without over- or under-treating conditions.

For example:

  • Does your doctor practice evidence-based medicine to determine the use of certain tests?
  • If appropriate, is physical therapy considered an option before sending patients for surgery?  

Patient health outcomes

We assess how well providers deliver high-quality care that makes a real difference in people's lives and promotes long-term healthy lifestyles.

For example:

  • Do their patients get screened and counseled for behaviors like smoking or vaping?
  • Do their patients manage chronic conditions well?  

Cost efficiency

We assess how well providers deliver excellent care to ensure the best possible outcomes for their patients while being mindful of costs.

For example:

  • Does your primary care provider treat routine conditions before referring you to a specialist?
  • Do their total costs (visits, labs, treatments) align with expectations for their unique patients?

Commitment to excellence

We evaluate and support Michigan healthcare providers who team up with us to enhance patient experiences, share knowledge, and strive for excellent health outcomes for the people they care for.

For example:

  • Does this provider take a holistic approach to caring for you by considering your physical, behavioral and social needs?
  • Do they coordinate your care in a team-based approach with other providers, then follow up with you?
  • Do they offer extended hours and virtual care?

Questions?

Privacy issues: To report a concern or if you think your protected health information has been compromised, please call us at 1-800-552-8278 or email us. Don't include any protected health information in your email. 

Other issues: For customer service, call the number on the back of your member ID card.