By the Numbers

We do a lot, and we do it well.

 

By the Numbers: 2008 Statistics

VSHP is quick and accurate. 

  • In 2008, we processed 4,581,839 claims.  Approximately 92.2% of these were paid within 30 days and 99.3% were processed within 60 days, with an accuracy rate of 99.6%.
  • In 2008, we have answered 286,874 member phone calls with an average speed of answer of 63.85 seconds.
  • In 2008, we answered 202,898 provider phone calls with an average speed of answer of 117.33 seconds.
  • In 2008 (Jan-Aug), we responded to 63,027 requests for authorization of medical services; and 71,565 provider calls with an average speed of answer of less than 30 seconds.
  • In 2008, we have handled 2,389 member appeals, 401 standard provider appeals and 17 provider disputes. 

VSHP provides individual service.

  • In 2008, we have directly assisted 10,065 members in scheduling appointments with specialists.
  • In 2008 (Jan-Sept), we provided Emergency Services Management (ESM) for 2,856 members who over utilize the emergency room.  The ESM program offers appropriate care protocols tailored to the health care needs of the member thus shifting the member focus from crisis intervention to prevention.
  • In 2008 (Jan – Sept), we provided disease management services for 21,181 members who have been identified with diabetes, heart failure, asthma, pregnancy, coronary artery disease, obesity, and COPD.  The purpose of the programs is to increase the patient’s knowledge of their condition and self-care management through education and intervention in order to help promote healthy lifestyles and reduce the impact of the condition.  We mailed introductory disease management packets to 13,732 members in the West.
  • In 2008, we provided case management services to 8,013 members who needed a transplant, had a terminal illness; a major trauma or severe injury, a cognitive or physical disability, a high-risk OB condition, and/or complex care needs.  Our case management program promotes quality and cost-effective coordination for members with complicated care needs without unnecessary interruption or delay in services.
  • In 2008, we worked with the Department of Children’s Services (DCS) to ensure that 4,428 children entering state custody received immediate eligibility and access to TennCare benefits.
  • In 2008, we answered 9,788 calls from DCS caseworkers to coordinate medical care, PCP assignments and other needs for children in State custody. 

VSHP offers broad provider networks and monitors quality of care.

  • We maintain provider networks of approximately 24,512 physicians, hospitals and other healthcare professionals to serve our members.
  • Through our credentialing process we assess the quality and safety of services provided by network practitioners and providers to BCBST members.
  • Our clinical audit department performs office site audits, medical record reviews, and EPSDT compliance audits for BlueCare/TennCareSelect network providers.
  • Our clinical risk management program promotes quality of care and member safety by investigating member complaints.  Approximately 8,700 complaints are received per year with more than 600 warranting further investigation.
  • In individual cases where there are no appropriate specialists in the network, VSHP tries to arrange with an out-of-network specialist to provide care for that member at VSHP rates.
  • Our medical directors participate in quarterly regional advisory panels that provide for open communication between practitioners, facilities and BCBST on quality, criteria and risk issues specific to TennCareSelect and BlueCare.
  • Our medical directors and nurse clinicians communicate with the behavioral health medical directors to ensure that coordination of medical and behavioral care occurs.
  • Our Utilization Review Medical Directors welcome opportunities to discuss UR decisions with our providers, and they work closely with Case Managers as Medical Advisors on complex cases.
  • Our NCQA re-accreditation was obtained in November 2009 and is currently at the Commendable level.  Outcomes and member satisfaction are monitored through the NCQA HEDIS® and CAHPS® process.

VSHP works to improve the health of members.

  • In 2008, we contacted 136,799 members, scheduled 1,268 appointments, and mailed 1,206,699 EPSDT and adult preventive educational materials to members.
  • Provided on-site education to primary care practitioners on EPSDT requirements to ensure completeness of screens, proper medical chart documentation, and proper billing of EPSDT services, emphasizing referral follow-ups for appropriate treatment. 
  • We also provide a health information library with around-the-clock telephone access to 1,134 general health-related topics, 248 women’s topics, and 274 parenting topics.  There are 620 Spanish topics.   Members use this service an average of 1,340 times per month and 16,077 times per year.

VSHP helps the state. 

  • In 2008, we saved the state $9,351,606.33 in recoveries from third party insurers, and avoided paying another $69,167665.75  through coordination of benefits with these insurers.
  • In 2008, we have saved the state $6,297,065  in recoveries through provider audit programs.
  • Provided cost, utilization, and other key data to the Bureau for managing the TennCare Program.

Of the state’s largest health insurers, only BCBST participates in TennCare.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)