BlueCross Medicare Advantage PPO Plan Earns Sixth Consecutive 4-Star Quality Rating

BlueCross BlueCross articles

BCBST News Center, John Hawbaker, October 20, 2020

CMS survey for 2021 highlights plan’s continued commitment to positive health outcomes and member experience

CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee’s Medicare Advantage PPO plan has earned a 4- out of 5-Star quality rating from the Centers for Medicare & Medicaid Services (CMS) for the sixth year in a row, an achievement that includes cumulative 4-Star performance on both the overall pharmacy and medical measures.

CMS issues ratings annually following a review of plans’ member outcomes, operations and customer surveys across a number of areas. Medicare Advantage plans with prescription drug coverage are rated on up to 40 unique quality and performance measures. The quality measures that made up this year’s ranking included:

  • Whether members get recommended screenings and health care in a timely manner;
  • How well members’ chronic health concerns are managed; and
  • Members’ overall satisfaction with their health plan.

The BlueCross Medicare Advantage PPO earned high rankings in several areas, including 5-Star ratings for customer service call center performance. The plan also received four stars on all of the survey’s medication adherence measures, highlighting how well BlueCross supports MA members in following their doctor’s recommended plan of care.

“We have consistently focused on outreach – connecting with our members so they understand their benefits and their providers’ care instructions, and working with providers to help patients stay healthy,” said Annamarie Rakes, director of quality improvement for senior products at BlueCross. “We remain dedicated to continuously improving the health care experience to make it more efficient and effective for those we serve.”

The BlueCross Medicare Advantage team collaborates with providers and members in a variety of ways to help improve health outcomes. These efforts, which were even more critical during the COVID-19 national public health emergency, include:

  • Arranging checkups or home-based assessments for members with transportation issues or limited mobility;
  • Coordinating home meal delivery to members discharged from an inpatient stay; and
  • Routine selective outreach to pharmacists and clinicians throughout Tennessee to identify and support members who may not be taking medications as prescribed.

With a strong focus on quality, BlueCross also launched a condition-specific special needs plan (C-SNP) at the beginning of 2020 to provide targeted support to diabetic Medicare Advantage members. The organization intends to expand the C-SNP plan in 2021 to ensure members with select cardiovascular issues or diabetes have access to needed resources and benefits to help them manage their underlying chronic conditions.

Dr. J.B. Sobel, vice president and chief medical officer for senior products at BlueCross BlueShield of Tennessee, says the organization’s continued success comes from a sustained focus on providing the right support at the right time – a focus that has been especially important in the COVID-19 era.

“During the pandemic, we’ve emphasized meeting members where they are and working alongside providers across the state to support care delivery with efforts that included suspending copayments for virtual telehealth visits,” he said. “More than ever, we understand the value of empowering clinicians with the information and tools needed to support quality care in a variety of ways.”

About BlueCross®

BlueCross BlueShield of Tennessee is a taxpaying, not-for-profit health plan serving more than 3.5 million members in Tennessee and around the country. The Chattanooga-based company was founded in 1945 and is celebrating its 75th anniversary of bringing peace of mind to its members and local communities. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. BlueAdvantage is a PPO plan with a Medicare contract. BlueEssential is a Special Needs Plan (SNP) with a Medicare contract. Enrollment in BlueAdvantage and BlueEssential depends upon contract renewal. For more information, visit the company’s news center at bcbstnews.com or visit the company’s website at bcbst.com.

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