Quality Improvement Program

Quality Initiatives

BlueAdvantage ℠ Quality Safety MEASURES Guide for 2013

Important Quality Focus Areas

Cholesterol Management (medication adherence)

The BlueAdvantage product is seeing a decrease in compliance to lipid-lowering medication for members with hypercholesterolemia. To assist with quality improvement efforts, we are requesting that you please consider counseling patients on the importance of adhering to the drug regimen if it has not already been done. If you identify barriers to adherence, resolve those barriers and find ways to help the member take his or her medication as directed.

Fall Prevention

If you are treating patients 65 and older, please assist us in reducing fall risk. According to the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, patients taking a tricyclic antidepressant, anti-psychotic or sleep agent can pose a higher fall risk for their age group. If you have patients taking these medications and it has not already been done, please consider a safer alternative if clinically appropriate.


The American Cancer Society recommends a yearly mammogram for patients aged 40-69 because it has been shown to reduce mortality. To assist us with our quality improvement efforts, please consider ordering a mammogram for any patients in this age group if it has not already been done.

Diabetics Screenings

For treating diabetic patients, the American Diabetes Association recommends: - annual dilated retinal exams in diabetic patients to screen for diabetic retinopathy - annual screening for urine microalbuminuria in a diabetic patient.   - measuring a fasting lipid profile in most diabetic patients annually. - a HbA1c be performed at least two times per year. Please consider referring your patients today for these important tests if not already done.

Bladder Control

Our most current Medicare Health Outcomes Survey results indicate a need to improve performance related to bladder control in the Medicare Advantage membership. To assist us with quality improvement efforts, please consider assessing your Medicare-aged patients to determine if they are having problems with urinary incontinence. Be sure to address urinary problems and document possible treatment options such as: • Behavioral therapies such as bladder training and techniques for pelvic muscle rehabilitation (Low-intensity behavioral therapies are ideal first-line interventions that are inexpensive, pose a low risk and can be initiated effectively by primary care providers) • Pharmacologic therapies • Surgical therapies (if indicated) Also, please make efforts to ensure your patient understands services rendered.

Stress management/depression screening

Providers, please remember that the holidays for your senior patients can be filled with busy schedules, shopping, and laughter, but also there can be feelings of tension, stress and loss. For many people, the holidays mean spending time with family and friends but for others, this can be a frustrating and anxiety-provoking time.  Seniors may worry that they do not have the resources to buy the food and gifts they wish for their families.  They may also acutely feel losses and changes in their lives.  It is important to be aware of the issues your seniors face in order to ensure that they are getting needed referrals for support.


What is BlueAccess?
BlueAccess enables you to view up-to-date policy and claim information in a secure online environment.