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Member Materials

Helping you manage all the moving pieces

Health care can be overwhelming, so we’re here to help you stay on top of it. Here are some links to help you get started.

Member Handbooks

Quality Improvement program

How we measure up

At Anthem Blue Cross and Blue Shield Healthcare Solutions, your health is important to us — and our experienced team can help you stay focused on it. To help us serve you the best we can, we closely look at the access to medical care and programs we give you each year. We measure the quality and safety of the services we provide. The results tell us what works the best and what needs to be improved. The Quality Improvement program is the process of finding how we can improve your care.

What tells us how we’re doing?

Our scores in 2016 and 2017

To measure how we’re doing, we use tools from professional organizations, like:

  • Healthcare Effectiveness Data and Information Set (HEDIS®) — to measure quality of care and services
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®) — a member satisfaction survey

National and state quality programs

National Committee for Quality Assurance (NCQA)

Anthem maintains national accreditation through the NCQA. NCQA uses surveys and HEDIS scores to look at our:

  • Policy and procedures.
  • Quality programs.
  • Customer satisfaction.
  • Quality and access to care.

This year, we want to make sure that:

  • All our members get quality health care and service.
  • We understand all our members’ cultures and languages.
  • We work to improve the health of our members.
  • We help our members stay well and manage their health care needs.

2018 Healthcare Effectiveness Data and Information Set (HEDIS)

The information from HEDIS helps us make sure you are getting the services you need. These services help keep you healthy or find health problems early so they can be treated sooner. We keep track of over 75 items. The data here reflects calendar year 2017 results. We compared it to the average Medicaid rate in the United States.

In the past year, we improved in the following areas:

2018 HEDIS results
Measures
Population
2016
2017
Change (% points increase)
Child Access to Primary Care
for Ages 12m-24m
Aggregate
93.99%
95.05%
1.05%
Child Access to Primary Care
for Ages 25m-6y
Aggregate
82.63%
84.39%
1.76%
Diabetes Care Test (A1c)
Aggregate
78.70%
82.48%
3.78%
Adolescent Well Care Visit
Aggregate
47.45%
53.77%
6.32%

2018 Consumer Assessment of Healthcare Providers and Systems (CAHPS)

To measure how we’re doing, we also use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey tells us what members think about issues that are most important to them, like how easy it is to get care.

In the past year, we improved in the following areas:

2018 CAHPS results
CAHPS Category
Population
2017
2018
Change (% points increase)
Rating of Health Plan
Adult
48.44%
51.91%
3.47%
Getting Needed Care
Adult
46.10%
48.22%
2.12%
Getting Care Quickly
Adult
52.71%
54.68%
1.97%
Health Promotion and Education
Adult
69.21%
74.87%
5.66%
Getting Care Quickly
Child
80.72%
88.06%
7.34%
Coordination of Care
Child
75.61%
80.56%
4.95%

Learn more about Quality Management

Have question about the Quality Management program?

Call us or write to us.  We can talk to you about:

  • What quality management is.
  • How we are doing and what our goals are.
  • How we are working to make things better for you.

We can also send you information on our Quality Management program. Call 844-396-2329 (TTY 711).
Ask us to mail you a copy of the program with goals, process and results. We can also tell you more about how we make sure you get quality care.

NCQA Newsletters

2017

About Anthem Blue Cross and Blue Shield Healthcare Solutions

Anthem has been helping members with limited income get quality health care in Clark and Washoe counties since February 2009. If you’re eligible for Medicaid or Nevada Check Up, you can enroll with Anthem to get all your regular benefits plus extras just for our members.

For more information about Nevada Medicaid or Nevada Check Up or to sign up with Anthem, visit our Nevada Medicaid or Nevada Check Up page.

Nevada Medicaid Nevada Check Up