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®). Our policies and programs section shares information that’s in place to protect our members.
You’ll also find a communications and resources section with guides, HEDIS Measures Tip Sheets, bulletins and FAQs, and some member materials. Also included is information about CMS surveys used to measure our members’ experiences, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), Qualified Health Plan, and the Health Outcomes Surveys. The surveys ask patients to rate and share their experiences with their health care providers and plans, including hospitals, doctors, drug plans, and others.
Click on the links below for details.
Policies and 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:
- Are often less likely to comply with prescribed treatment and self-care regimens.
- Fail to seek preventive care and are at a higher risk (more than double) for hospitalizations.
- Remain in the hospital nearly two days longer than adults with higher health literacy.
- Often require additional care that results in annual health care costs that are four times higher than those with higher literacy skills.
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.
- Physicians Can Review Criteria, September 2016
- Preventive Services and Practice Guidelines are Online, September 2016
- Quality Improvement Programs Respond to Customer Expectations, September 2016
- Quality Performance Indicators, September 2016
- We Continually Assess New Technology, September 2016
Communications and Resources
- HEDIS Documentation and Coding Guide, November 2017
- Stars Reference Guide, May 2017
- HEDIS Stars Quick Cue Sheet, January 2017
- Call Utilization Management When You Need Support, September 2016
- Case Management Helps Members Navigate The Health Care System
- Documentation of Care Review, September 2016
- Financial Incentives Not A Factor in Coverage Decisions, September 2016
- Helping Members Make Informed Decisions, September 2016
- Member Grievance and Appeal Process, September 2016
- Members Have Rights and Responsibilities, September 2016
- Our Disease Management Programs Can Help Your Patients, September 2016
- HEDIS Measures Tip Sheets
- Acute Bronchitis (AAB): Avoidance of Antibiotics in Adults with AAB -- Primary Care Physicians, Sept. 2016
- Acute Bronchitis (AAB): Avoidance of Antibiotics in Adults with AAB -- Urgent Care, Sept. 2016
- Asthma Medication Ratio, July 2017
- Asthma: Medication Management for People with Asthma, July 2017
- 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, December 2016
- Cardiovascular Disease: Statin Use in Patients with Cardiovascular Disease (SPC), March 2017
- Care of Older Adults (COA), December 2017
- Cervical Cancer Screening, December 2016
- Colorectal Cancer Screening (COL), May 2017
- Comprehensive Diabetes Care, July 2016
- COPD: Pharmacotherapy Management of COPD Exacerbation, February 2017
- Diabetes Care Retinal Exam (DRE), October 2017
- Diabetes-Statin Use in Persons with Diabetes (SUPD) PQA Measure, March 2017
- Medication Reconciliation Post-Discharge, January 2017
- Osteoporosis Management in Women (OMW), October 2016
- Rheumatoid Arthritis (ART): Disease-Modifying Anti-Rheumatic Drug Therapy, March 2017
- Transitions of Care (TRC), November 2017
- Weight Assessment and Counseling in Children (WCC), July 2017
- Well Child Visit (W15), April 2017
- Bulletins and FAQs
- HEDIS Clinical Quality Validation FAQs Update, December 2017
- HEDIS Clinical Quality Validation Form Backlog, November 2017
- HEDIS Care Gaps & Availity Gateway Update, November 2017
- Enrollment & Benefits Care Reminders in Availity, September 2017
- HEDIS Care Gaps and Assessment Forms Updates, September 2017
- UPDATED HEDIS Care Gaps & Risk Assessment Forms Update, September 2017
- HEDIS Care Gaps & Risk Assessment Forms Update, June 2017
- Use the Right CPT II Codes to Show Care is Complete, April 2017
- New 2017 HEDIS Care Gaps Tool, April 2017
- CAHPS Survey: How You Can Influence Your Patients’ Health Care Experience, March 2017
- HEDIS Care Gaps Form, March 2017
- CAHPS Quick Reference Guide for Physicians, March 2017
- HEDIS FAQs, January 2017
- Frequently Asked Questions: HEDIS Attestations, November 2016
- What are HEDIS, CAHPS, and HOS? August 2016
- Accreditation and HEDIS Update, June 2016
- Let's Work Together to Help Your Florida Blue Patients Understand Blood Pressure, May 2016
- Member/Patient Communications
- CMS Surveys Used to Measure Members’ Experiences (CAHPS, QHP, HOS)
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.
FB PRV PROG 102017
- CMS Surveys Used to Measure Members’ Experiences (CAHPS, QHP, HOS)