Quality Counts in Care and Service
We’re committed to quality care and service and fully support standards established by federal and state regulatory agencies, and accrediting bodies, including the National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data Information Set (HEDIS®).
Click on the links below for more information about Quality / HEDIS / CAHPS
Policies & Programs
- Advance Directives
Florida Blue is required by federal regulations to provide certain information to Medicare Advantage members about advance directives in the State of Florida. Under Florida law, a person has the right to decide the type, amount, and duration of the medical care he or she receives. A member also has the right to appoint a representative to facilitate care or treatment decisions, including decisions about withholding resuscitative services or withdrawing life sustaining treatment, when the member is unable to do so.
It’s the policy of Florida Blue to recognize the right of each member to make health care treatment decisions according to his or her personal beliefs. Each member has a right to decide whether to execute an advance directive to guide treatment decisions in the event the member becomes unable to do so. Florida Blue will not interfere with, and will respect, a member’s decision in accordance with Florida state laws. It’s the member’s responsibility to provide notification to his or her physician that an advance directive exists.
Members may obtain information about advance directives from the following sources:
- Physicians or health care workers
- Hospitals or skilled nursing facilities, and/or
- The AHCA website
The Advance Directive – Living Will Forms are available for providers to give their patients to help them share their life planning and care decisions to family, friends, and health care providers.
Members may contact AHCA at the address below if they wish to submit a complaint about non-compliance with advance directive requirements:
Florida Agency for Health Care Administration
Bureau of Managed Care
2727 Mahan Drive
Mail Stop 26, Bldg. 1, Room 333A
Tallahassee, FL 32308
Phone: (888) 419-3456
TDD (800) 955-8771
- Patient Health Literacy
Chances are that some of your patients are among the millions of people in the United States whose health may be at risk because of difficulty in understanding and acting on health information.
Health literacy is the ability to read, understand and effectively use basic medical instructions and information. Low health literacy can affect anyone of any age, ethnicity, and background or education level.
People with low health literacy:
You may not even know that these patients are in your practice because:
- They are often embarrassed to admit they have difficulty understanding health information and instructions.
- They use coping mechanisms that effectively mask their problem.
What you can do to improve health literacy
- Partner with the Partnership for Clear Health Communication at the National Patient Safety FoundationTM. The Partnership for Clear Communication is a coalition of national organizations that are working together to promote awareness and solutions around the issue of low health literacy and its effect on safe care and health outcomes.
- Ask Me 3TM is an educational program provided by the Partnership for Clear Health Communication. Visit their website at www.npsf.org/askme3 for brochures to post in your waiting and exam rooms and for distributing to your patients.
- Call Utilization Management When You Need Support
- Case Management Helps Members Navigate the Health Care System
- Financial Incentives Not a Factor in Coverage Decisions
- Helping Members Make Informed Decisions
- Members Have Rights and Responsibilities
- Physicians Can Review Criteria
CMS Member Experience Surveys
CMS develops and administers many different patient experience surveys. Surveys ask patients about their experiences with, and ratings of, their health care providers and plans, including hospitals, doctors, drug plans, and others.
CAHPS and QHP Enrollee Surveys
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey is a mandated regulatory/accreditation survey sent to a select number of Medicare and commercial members annually. CAHPS results are an integral part of the CMS Star ratings, Health Plan Accreditation, and NCQA Health Insurance Plan Ratings.
As part of the new rating system for the Marketplace (Exchange) plans, members are surveyed using the Qualified Health Plan Enrollee Experience Survey (EES or QHP Enrollee Survey) which is similar to CAHPS. With the Federal Employee Program (FEP), members receive a similar version of the CAHPS survey, which is used by FEP to rate their members experience with the health plan.
CAHPS/EES collects information on consumers’ experiences with their health plan, personal doctor, specialists, and health care in general and is used for CMS Star ratings. It has become the national standard for measuring and reporting on consumers’ experiences with their health plans.
The Medicare Health Outcomes Survey (HOS), utilized for CMS Star ratings, is a patient-reported outcomes measure used in Medicare managed care. According to CMS, the goal of the HOS program is to gather valid and reliable clinically meaningful data that have many uses, such as targeting quality improvement activities and resources; monitoring health plan performance and rewarding top-performing health plans; helping the Medicare-covered make informed health care choices; and advancing the science of functional health outcomes.
Provider & Member Communications
Note: To refer to the CMS Stars HEDIS Measures, visit Medicare Stars
- Acute Bronchitis (AAB): Avoidance of Antibiotics in Adults with Acute Bronchitis, February 2018
- Asthma Medication Ratio (AMR), May 2018
- Asthma: Medication Management for People with Asthma (MMA), May 2018
- Back Pain: Use of Imaging Studies for Low Back Pain, October 2016
- Blood Pressure: Controlling Blood Pressure, January 2017
- Body Mass Index: Adult BMI Assessment, January 2017
- Breast Cancer Screening, April 2018
- Cardiovascular Disease: Statin Use in Patients with Cardiovascular Disease (SPC), April 2018
- Care for Older Adults (COA), May 2018
- Cervical Cancer Screening, May 2018
- Colorectal Cancer Screening (COL), May 2017
- COPD: Pharmacotherapy Management of COPD Exacerbation, February 2017
- Diabetes: Comprehensive Diabetes Care, July 2016
- Diabetes Care Retinal Exam (DRE), October 2017
- Diabetes: Statin Use in Persons with Diabetes (SUPD) PQA Measure, July 2018
- Medication Reconciliation Post-Discharge (MRP), May 2018
- Opioids: Use of Opioids From Multiple Providers (UOP), January 2018
- Osteoporosis Management in Women (OMW), October 2016
- Rheumatoid Arthritis (ART): Disease-Modifying Anti-Rheumatic Drug Therapy, March 2017
- Statin Use in Patients with Cardiovascular Disease (SPC), April 2018
- Statin Use in Persons with Diabetes (SUPD) PQA Measure, July 2018
- Transitions of Care (TRC), May 2018
- Weight Assessment and Counseling in Children (WCC), July 2017
- Well-Child Visit (W15), March 2018
Identifying Patients’ Care Gaps
- Care Gap Reminders
Make sure your patients receive their recommended care including annual and periodic preventive screenings in a timely manner.
In Availity, you will see important patient care reminders when checking our members’ eligibility for care and services. Care reminders will be based on clinical and administration information1 previously sent to us.
1 Information may not always be complete or accurate. Care reminders are never a substitute for professional judgement.
- Quality & Efficiency Reporting Portal Tool (QERP)
The Quality & Efficiency Reporting Portal (QERP), located in Availity under Florida Blue’s Passport web portal, allows primary care physician practices a way to compile data, identify cost, quality, and utilization and administration improvement opportunities. It is important for practices to review this information regularly as it impacts their patient population, incentive opportunities for closing patient care gaps, and more.
Utilization of the QERP tool is aligned to participation in the Medicare Advantage network and BlueMedicare Provider Quality Bonus program. For information about our BlueMedicare Provider Quality Bonus Program visit the Florida Blue Passport web portal at Availity.com.
For QERP educational training, contact your network manager.