Quality Program
The Quality Program (QP) supports Regence’s commitment to ongoing quality
care for our members. We have developed standards and performance goals and
continue to monitor them to identify improvement opportunities.
Participation in the Quality Program
Participation in Regence QP activities is required in our agreements with
physicians, other health care professionals and facilities. Participation may
include:
- Site visits and record review
- Adherence to clinical standards
- Credentialing or re-credentialing
- Quality of care concerns or complaints
- Providing evidence of preventive health promotion
- Providing data for various medical records audits such as the annual Healthcare
Effectiveness Data and Information Set (HEDIS®) audit
Providers may be asked to review and provide feedback on proposed or ongoing
clinical activities and development of clinical practice guidelines at focus
groups or Medical Advisory Committees.
Quality Program scope
The scope of the QP includes developing improvement opportunities and activities
throughout Regence that directly impact the experience of our members, physicians,
other health care professionals or facilities:
Develop focused quality improvement activities (QIAs) including:
- Clinical QIAs
- Service QIAs
Monitor activities throughout Regence to further the “integration of
our processes” including:
- Access
- Availability
- Quality surveys
- Case Management
- Advance directives
- Member satisfaction
- Provider satisfaction
- Inter Rater Reliability
- Medical record keeping
- Quality of care concerns
- Community collaboration
- Under and over utilization
- Pharmacy education programs
- Disease management programs
- Clinician performance monitoring
- Coaching and wellness programs
- Utilization Management: Physical and Behavioral Health
Monitor patient safety activities to fulfill our commitment to the safe delivery
of care to our members.
Support contractual and regulatory compliance.
Develop and administer the QP to provide an organizational structure, resources
and coordination of quality processes within Regence.
Regence Health Strategies Committee of the Regence Board of Directors
The Regence Board of Directors has participating providers as directors and
on the Health Strategies Committee. This committee meets quarterly
to discuss issues surrounding the health care delivery system and provider-related
quality improvement activities.
| Learn more about |
Description of information |
| Accessibility and Availability Standards |
To ensure that our members have services they need at any given time, providers should comply with these minimum standards for availability. |
| Advance Directives |
To ensure our members’ wishes are met concerning the provision of health care if the member becomes incapacitated and is unable to make those wishes known, please comply with our advance directive requirements. |
| Blue Physician Recognition (BPR) |
The BPR Program is designed to reinforce Blue Plans’ commitment to quality by providing more meaningful and consistent information on physician quality improvement and recognition on the Blue National Doctor & Hospital Finder. |
| HEDIS Reporting |
HEDIS is a component of the Quality Program and used by health plans to measure performance on dimensions of care and service. HEDIS includes Medicaid and Medicare. Regence is required to report annual HEDIS values on various populations. |
| Physician Quality Measurement (PQM) |
The goal of the PQM Program is to provide physician performance measurement information to Blue Plan members to raise their awareness of clinical quality measures used by providers across Blue Plans. |
| Provider Advisory Groups |
Advisory panels meet at least semi-annually and provide information to the Quality Program Coordinator and others. |
| Site Review Standards |
In order to provide a sanitary, comfortable experience, participating physicians, other health care professionals, facilities and agree to adhere to site standards. Offices will be regularly reviewed to ensure compliance with these standards. |
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