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Provider Quality Programs

National and regional studies show that informed patients make better health care decisions. They’re likely to be more engaged with you and your staff and more active participants in their own care. To help keep members informed about the quality of the care available and enable them to make informed health care decisions, HMSA is working with the Blue Cross and Blue Shield Association (BCBSA) on some new transparency initiatives, including a series of online tools designed to give our members information about quality, cost, and other important considerations when they choose a provider.

Blue Physician Recognition Program

HMSA is excited to bring the new Blue Physician Recognition (BPR) program to Hawaii. BPR reinforces HMSA’s commitment to quality by providing information on physician quality improvement and recognition through the Blue National Doctor & Hospital Finder site and Federal Employee Plan (FEP) online directory. Any individual provider, group, or practice’s participation in HMSA’s pay-for-performance quality improvement programs – and in national or regional improvement and/or recognition programs – may be acknowledged through the BPR Program. Access to this key information about HMSA participating primary care providers and specialists will help members make informed health care decisions.

Physician Quality Measurement Program

In conjunction with the Blue Physician Recognition (BPR) program for all providers, the Physician Quality Measurement (PQM) Program will provide even more meaningful and consistent information on primary care providers. The PQM program displays performance, quality, improvement, and recognition on select HEDIS® physician performance measures. A renewed emphasis on primary care is a fundamental part of HMSA’s efforts to improve quality and address the risings costs of care. PQM provides members with an unprecedented level of transparency about the quality of care provided by HMSA participating primary care providers.

Patient Review of Physicians

To supplement the information from BPR and PQM, which are based on national standards, members also have access to Patient Review of Physicians (PRP). The PRP features ratings and reviews written by patients about their experiences receiving care from HMSA participating providers. Members who log in must verify their visit with a provider. They will be able to create their own ratings and reviews of their experience. Office visits will be confirmed before posting, and members will be limited to one comment per provider claim. By providing a consumer-level perspective, HMSA offers the most robust, up-to-date information available to help members choose the best care for their needs. The PRP will also be a useful tool for providers to offer greater engagement to their patients. You will have the ability to read, respond to, and request removal of comments. BCBSA has designed the PRP with an emphasis on security, moderation, and verifiability so that it may serve as a more reliable tool than the many unaffiliated sites that already exist on the Internet.