Moving the Needle: Closing Gaps To Improve Outcomes for Our Members

December 2023

Moving the Needle: Closing Gaps To Improve Outcomes for Our Members

Quality measures, including Healthcare Effectiveness Data and Information Set measures from the National Committee for Quality Assurance, help our members receive appropriate care that supports their health and wellbeing.

HEDIS^® is a scorecard to track how our members benefit from preventive health care services. The eight measures with the lowest scores show the highest gaps in care, based on claims data. We’re taking a closer look at why some areas are falling short.

More education may be needed to show why preventive care is important.
Members with chronic conditions may not be aware of what they can do to better manage their care.
Some members may have barriers to getting care due to social determinants of health.

Blue Cross and Blue Shield of Illinois conducts ongoing member outreach campaigns and we’re active in the communities we serve. We offer education and support, but the best way to reach our members is by partnering with their trusted health care providers.

Below are resources on measures where our members may need your help. We hope you find this information helpful when you’re talking with your patients.

Maternal and Infant Health
These articles focus on prenatal and postpartum care, and well-child visits in the first 15 months:

Colorectal Cancer Screening
We publish updates to improve cancer screening rates. These articles include reminders and discussion points for providers:

Behavioral Health
These articles spotlight depression, antidepressant management and post-hospitalization follow-up to increase awareness:

Diabetes
These resources offer reminders on the importance of eye exams and kidney evaluation for patients with diabetes:

We also encourage you to visit our Health Equity and Social Determinants of Health page for more information, ideas and related resources.

HEDIS is a registered trademark of the NCQA.

This material is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials. References to other third party sources or organizations are not a representation, warranty or endorsement of such resources or organizations. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

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for Providers