Quality Programs

  • The Quality Program supports Premera's mission: to provide peace of mind to members about their healthcare coverage. We do this by providing a framework for ongoing evaluation and communication designed to improve member health and the quality and safety of care and service experienced by our customers. Our Quality Program benefits Premera members across every plan and service. We work with you to monitor and improve the care you provide. The Quality Improvement Committee conducts a formal, system-wide quality assessment annually, which includes an annual program evaluation of the quality of its health services. View Quality Program Report Card.

    Quality components

    Health awareness education

    We identify members in need of preventive services and encourage them to receive these important services. Preventive services include:

    • Check-ups
    • Screening tests/exams and
    • Immunizations

    Premera Preventive Health Guidelines describe appropriate preventive care for all members based on age, gender and risk factors. Premera endorses the US Preventive Services Task Force. View Guide to Clinical Preventive Services (Adult) and Guide to Clinical Preventive Services (Children/Adolescents).

    Health risk management for groups of 200 or more

    Our new Health Risk Management program provides a proactive approach to helping members identify and reduce specific health risk factors, through healthier lifestyle choices. The program integrates data and services to address an individual's specific risk factors, and is designed to increase productivity and improve overall quality of life.

    Clinical practice guidelines

    Whenever possible, Premera endorses evidence-based national guidelines for medical treatment of those conditions addressed by Premera disease management programs, quality and pharmacy programs. If national guidelines are not available, medical research and literature is reviewed and practitioners with appropriate expertise collaborate with Premera staff to develop guideline recommendations. The Premera Clinical Quality Improvement Committee reviews and approves new guidelines and recommendations for endorsement of national guidelines. All guidelines are reviewed and updated at least every two years.

    View the Clinical Practice Guidelines used in our Disease Management Program.

    Quality of care complaint review

    If a member, practitioner or Premera associate expresses concern about the quality of care received by one of our members, we take the following steps:

    • Document and investigate their concern
    • Conduct an investigation observing strict confidentiality
    • Request pertinent information and/or medical record documentation as needed
    • Seek review by Premera senior medical directors, peers or Board-certified specialists as needed

    Patient safety

    Premera promotes awareness and educational activities that are aligned with the national focus on patient safety. We distribute information to members that equips them to take an active role in their healthcare. We also distribute information, industry standards and national resources designed to help physicians and other providers improve the safety of care delivery.