Clinical Quality Management

Policy Number: GP-X-061

Last Updated: Aug. 29, 2022 

Blue Cross and Blue Shield of Nebraska (BCBSNE) maintains a Clinical Quality Management (CQM) program that aligns with our vision of creating a health care world without confusion that adds more good years to people’s lives. In support of this, programs are initiated to enhance care delivery, contribute to a positive member experience, and create a collaborative atmosphere with the provider community – all while improving the care and services your patients, our members, receive.  

The Clinical Quality Improvement (CQI) department coordinates and facilitates the CQM program, including but not limited to: 

  • URAC accreditation   
  • Accountable care organizations and patient-centered medical homes value-based care quality programs   
  • Preventive health and wellness   
  • Consumer safety and transparency   
  • Clinical quality improvement activities   
  • Health care safety and quality   
  • Provider office standards for:   
    • Practitioner offices   
    • Urgent care centers   
    • Appointment availability and access to care   

In compliance with regulatory requirements, programs are evaluated on a regular basis and results are reported annually to the Board of Directors.  

Communication and collaboration with providers in the BCBSNE networks, as well as professional and community organizations in Nebraska and nationally, contribute to the success of our program and demonstrates our commitment to high-quality care and service in Nebraska and beyond.