Quality Programs

Blue Physician Recognition

The Blue Physician Recognition (BPR) Program is designed to reinforce Blue Plans’ commitment to quality by providing more meaningful and consistent information on physician quality improvement and recognition on the Blue National Doctor & Hospital Finder site and FEP online directory. A BPR indicator will be used to identify physicians, groups and/or practices who have demonstrated their commitment to delivering quality and patient-centered care by participating in local, national, and/or regional quality improvement programs as determined by the local Blue Plan.

Blue Cross and Blue Shield of Nebraska is recognizing primary care physicians who are participating in the Primary Blue Patient Centered Medical Home with a BPR indicator.

Primary Blue Medical Home

Primary Blue is Blue Cross and Blue Shield of Nebraska’s patient centered medical home program. A patient centered medical home is a medical office or clinic where a team of health care professionals’ work together to provide a new and expanded type of patient cares.

It's primary mission is to:
  • To give the patient timely access to a personal primary care physician
  • To establish a continuous relationship between the patient and a personal primary care physician
  • To have the majority of the patient’s health care needs met in one office
  • To have the patient’s care coordinated and monitored in a proactive manner
BCBSNE believes the patient centered medical home can:
  • Improve the health of individuals.
  • Increase patient satisfaction.
  • Reduce hospitalizations and emergency room visits, and decrease overall healthcare costs.

Primary Blue focuses on chronic disease management (diabetes, congestive heart failure, coronary artery disease, hypertension, metabolic syndrome and asthma), as well as preventive services (BMI recording, colorectal cancer screening, breast cancer screening, cervical cancer screening, and immunizations).

Blue Cross and Blue Shield of Nebraska is recognizing physicians who are participating in the Primary Blue Patient Centered Medical Home with a BPR indicator.

Please contact a BCBSNE Health Network Consultant to submit application.

Radiology Quality Initiative (RQI)

Blue Cross and Blue Shield of Nebraska developed the RQI Program, administered by American Imaging Management® (AIM), to promote the most appropriate use of advanced imaging services provided to members. The program aligns with the goals of the Nebraska Health Care Reform Task Force - to promote high quality, affordable health care coverage and utilize best practices and practice guidelines to help reduce unnecessary medical expense.

 




HEALTH INSURANCE TERMS



Affordable Care act

The Affordable Care Act (ACA), sometimes called Obamacare, is a federal law designed to make health care more affordable, accessible and of higher quality.

COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

health insurance marketplace (exchange)

The government Website (healthcare.gov) where you can purchase health insurance and see if you qualify for a tax credit (subsidy) to help pay premiums and out-of-pocket costs. 

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy.

tax credit

Financial assistance from the government that helps those who are eligible pay for health insurance. Eligibility is generally determined by household income and family size.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider.