The Physician Quality Measurement (PQM) program lets you see how your doctor compares to other doctors in your area. This will help you know more and make more-informed decisions about where you go for healthcare.
Right now, Blue Cross shows PQM data for these types of doctors:
If your doctor is one of these types, we can show you PQM data for that doctor. The doctor will have a one, two or three-star rating for each of the different measures we look at for PQM data. This shows you whether that doctor’s performance, based on data from our health claims, is above average (three stars), average (two stars) or below average (one star) compared to other doctors.
A doctor’s PQM data may not be displayed if that doctor has not treated enough Blue Cross patients to give us data to show a ranking. Doctors can also ask not to have their PQM data displayed.
Through this program, we work with your primary care doctor to make it easier for you to get the care you need.
This program has benefits like health coaching and care coordination.
And, if your plan has copayments for primary care office visits, when you go to Quality Blue Primary Care doctors, you may not have to pay a copayment - we will waive it.
We put a “Blue Physician Recognition” indicator in our online Find a Doctor or Drug directory so you can see which doctors have achieved certain quality recognitions.
The Blue Physician Recognition (BPR) indicator is displayed next to doctors’ names in Find a Doctor/Hospital directory and on the Blue Cross and Blue Shield Association’s Blue National Doctor & Hospital Finder.
Doctors get a BPR indicator if they earn at least one of the following recognitions:
You can tell us what you thought of a doctor visit you had by giving a patient review.
You can also see the reviews other members have given by clicking the “Read Reviews” tab next to a doctor’s listing in the directory.
How can I submit a patient review?
We will hold your review for 24 hours so we can make sure your information is valid. After that, your review will displayed on the Blue Cross Find a Doctor/Hospital directory.
Blue Distinction is a national program that recognizes hospitals for their expertise in performing certain types of surgeries or specialty care. The national Blue Cross and Blue Shield Association offers this program, and the local Blue Cross plan gives the designations to hospitals and medical facilities if they demonstrate they are delivering high-quality, efficient, value-based, patient-centered care.
There are two categories:
The standards for Blue Distinction recognition are on the Blue Cross and Blue Shield Association’s webpage.
Hospitals/medical facilities can earn Blue Distinction recognition for these types of surgeries and specialty care:
In Louisiana, there are many hospitals that have earned Blue Distinction recognition, including many of the major health systems in the state. See the list of Louisiana’s Blue Distinction centers.
How do I know if a hospital has Blue Distinction recognition?
When you are looking for a hospital in our Find a Doctor/Hospital directory, the ones that are Blue Distinction Centers or Blue Distinction Centers+ have the program logos next to their names.
When a hospital gets Blue Distinction recognition, Blue Cross gives the hospital materials to do banners or posters that say the hospital is a Blue Distinction Center. You may see this in a hospital’s ads or commercials, too.
You can ask your doctor for help finding a Blue Distinction Center if you are not sure whether a hospital is one.
The Hospital Quality Program (HQP) rewards hospitals that take extra steps to improve patient safety and quality. The hospitals can earn incentives for these efforts.
This program is for acute general hospitals with 60 beds or more.
There are four main categories:
Blue Cross uses national measures for this program, and rates hospitals on data from publicly available sources or Blue Cross claims.
Hospitals earn incentives by either improving their current performance significantly or by achieving high performance.