Publication Date

Publication Date: 

As we informed you in May, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is consolidating the multiple patient care-gap reports we provide to our participating physicians and provider groups into one single report.

The new and improved July 2015 Provider Quality Report will be mailed to each practice in late July, along with detailed instructions on how to obtain the patient-level data and all future monthly reports via Blue eSM (please note that ONLY the July report will be mailed).

To see the full list of measures and detailed report information as it becomes available, please check out the “Provider Quality Reports” page on the

Here are some highlights of what you will see in the new Provider Quality Reports:



Comprehensive care-gap views

         -- 12-month rolling report

         -- Calendar year prospective report


The 12-Month Rolling Report provides a summary view of the current and previous 12 months. This pdf report contains both Medicare and commercial summary information. The Patient Detail Report in Excel will provide a prospective view of care gaps, including patient-level detail on prospective and open care gaps for both Medicare and commercial patients.


Robust measures list

         -- 10 priority measures for Medicare and   commercial

         -- 40+ additional HEDIS measures




Includes adult, pediatric and pharmacy measures



Easy-to-view details for 10 priority measures

         -- measure metrics

         -- measurement adherence trending



Metrics will show closed gaps, pending gaps, persistent gaps, and total member attribution.

Trending report will be in bar-graph format and will include current month, previous month, as well as the national 90% (commercial) or 5 Star Threshold (Medicare).



Measure adherence charts separated by commercial and Medicare membership




Both charts will show a list of all measures, including denominator, numerator, practice quality score, and benchmark scores. Commercial measures will show the National 90%; Medicare will show the 5-Star threshold. Performance on each measure will be color- coded to allow immediate visual prioritizing.



Opportunity analysis on the summary report



Shows opportunities for improvement, links to appropriate resources, and Blue Cross NC contact information.



Detailed member report (available in Blue e)




Displays only prospective care gaps. Ability to view gaps by measure, as well as by attributed individual physician. The patient-detail report will be produced in Excel and contain both Medicare and commercial members on separate tabs.



Please take a few minutes to take the following survey by June 30, and share your past experience with our quality reports and your preferences about how you’d like to receive them. We value your input!

Blue Cross NC Provider Quality Reports Survey:

Please contact Linda McKinnon RN, MSN, CCM, CPC, Blue Cross NC program manager, at (919) 765-4809, if you have any questions. Or you may email us at