Providers | Blue Shield of California Promise Health Plan

Quality Improvement

Quality Improvement

"Your doctor can freely communicate with you about your care and treatment options regardless of any benefit coverage limitations."

Blue Shield of California Promise Health Plan wants to make sure you get good care and services.

To help make this happen, we have created a complete Quality Improvement Program.
The goal of the program is to make sure that our promise of giving good care to our members in being met. The program measures many different parts of the care and services we offer. We have provided you some of our results on the links below.

You can request the results by calling our Quality Improvement Hotline at (800) 468-9935.

These measures include:

  • Studies to ensure that appointments are available
  • Studies to ensure that after-hours services are available
  • Studies to measure how long patients wait in the office for an appointment
  • Facility site reviews. This includes looking at access for disabled people
  • Making sure that the network of doctors in your area fits your needs
  • Patient satisfaction surveys
  • Doctor satisfaction surveys
  • Quality of care studies to assure appropriate:
    • Well child visits
    • Immunizations
    • Cervical cancer screening
    • Breast cancer screening
    • Diabetes
    • Asthma Care
    • High blood pressure
    • Prenatal and postpartum care
    • Cholesterol management

Access to Care Standards

Blue Shield of California Promise Health Plan uses guidelines to ensure that its members have access to care:

Initial Health Assessment (IHA)


QI Annual Evaluations/ Program Goals

Blue Shield of California Promise Health Plan administers a robust ongoing Quality Improvement Program with a goal to ensure that members receive the highest quality of care and services.


Blue Shield of California Promise Health Plan has also developed programs to help members with their medical conditions, which include:

  • Asthma Program (Medi-Cal)
  • Congestive Heart Failure Program (Medi-Cal and Medicare)
  • Coronary Heart Disease Program (Medi-Cal)
  • Chronic Obstructive Pulmonary Disease (Medicare)
  • Healthy Start Comprehensive Prenatal and Postpartum Program (Medi-Cal)

Clinical Practice Guidelines

Blue Shield of California Promise Health Plan Disease Management Programs adopts KRAMES Literature for Clinical Practice Guidelines


Back to Quality Improvement main page

You are leaving Blue Shield of California Promise Health Plan's website

If you enter the web site of KRAMES (http://www.kramesstore.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the KRAMES's web site that adheres to the rules, policies, regulations and, terms of use and services of that business.

You are leaving Blue Shield of California Health Plan's website

If you enter the web site of Krames on Demand (http://kod.staywellsolutionsonline.com/?accountId=0), please be aware that you will leave Blue Shield of California Health Plan's web site, and will be routed to the Krames on Demand's web site that adheres to the rules, policies, regulations and terms of use of that service.


OK, I understandCancel

You are leaving Blue Shield of California Promise Health Plan's website

If you enter the web site https://ocrportal.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Office for Civil Rights web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site http://www.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health & Human Services web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS's web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://www.ssa.gov/medicare/prescriptionhelp/, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medicare Prescription Drug Plan Costs web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://secure.ssa.gov/i1020/start, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Official Website of the U.S. Social Security Administration that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of Beacon Health Strategies (beaconhealthstrategies.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Beacon Health Strategies web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site My Advocate (www.myadvocatehelps.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the My Advocate web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site American Specialty Health (ASH) (www.ashlink.com/ash/ashco.aspx?hp=Care1st), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the ASH web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Dental Providers (www.deltadentalins.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Dental Providers web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Hearing Services/ Hearing Aids (www.epichearing.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Hearing Services web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site VSP (www.vsp.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the VSP web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site KEPRO (www.keproqio.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the KEPRO web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Livanta (www.bfccqioarea5.com ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Livanta web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site U.S. Department of Health and Human Services (ocrportal.hhs.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health and Human Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CalDuals (http://calduals.org/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CalDuals web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (https://www.dhcs.ca.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS (Centers for Medicare & Medicaid Services) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (DHCS) (https://www.healthcareoptions.dhcs.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services (DHCS) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Medi-Cal Dental Program (https://www.denti-cal.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medi-Cal Dental Program web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Solera4me (https://www.solera4me.com/bluepromisemedicare), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Solera4me web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Department of Managed Healthcare (http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Department of Managed Healthcare web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site.