Understanding Health Care Costs and Quality

Most health insurance plans offer you resources, tools and even savings on retail items. For example, you may get perks to help you save time and money, lose weight, quit smoking and even get discounts at retail stores. Here you'll find some helpful tips for making your health insurance plan work for you.

Making the Most of Your Medical Benefits

Medical benefits are probably the number 1 reason you chose to get health insurance. Here are a few simple things you can do to get the most out of your benefits.

  • Stay in the network. Most health plans have worked with doctors, hospitals and other health care experts to get discounts for in-network care. That often means lower out-of-pocket costs to you.
  • Use the ER for emergencies only. Real emergencies call for a trip to the closest emergency room (ER). But you can usually save money on your copay by going to your primary care provider (PCP) for colds, minor sprains and other less serious health issues.
  • Follow your doctor's orders. Be sure to take any medicines, treatments or therapies your doctor suggests. That way you can get better quickly and avoid extra costs.
  • Use generic drugs. Generic drugs cost less than brand name drugs and offer you the lowest available copay. Generic drugs often have the same ingredients and work the same as the brand-name option.
  • Use freestanding medical service facilities. You can usually lower medical costs by scheduling lab work, imaging and other outpatient services at freestanding medical service facilities instead of a full-service or general acute care hospital.
  • Know your coverage. Make sure services or treatments are covered before you plan your next doctor's visit. Knowing this ahead of time can save you money.
  • Do an "annual check-up" of your health plan. Make sure your plan still meets your needs. This is even more important if you had any major, life-changing events in the past year, such as getting married, having or adopting a child or having a dependent turn 26 and leave your plan.

Use Your Member Perks

Most health plans offer useful tools to their members. To get the most from your plan, take full advantage of these perks:

  • Get online. We offer a secure member website, Blue Access for MembersSMwhere you can check the status of claims, review benefits information, find a doctor and much more.
  • Take advantage of programs. If your plan has free health screenings or wellness programs, use them to better your health. For example, some have programs to help you lose weight and quit smoking with no extra cost to members.
  • Learn how to be healthy. We have information to help keep you and your family healthy. Sign up for newsletters, read articles online or find health and wellness tips.

Use Blue Access for Members

Blue Access for Members is the best way to get the most from your plan. With this secure members-only website, you can:

  • Manage your account online
  • Take a health assessment to get personalized wellness tips
  • Check the status of claims and set-up email alerts
  • Order a new member ID card and print a temporary card
  • Look into our special, members-only discounts and offers from health and wellness companies

Log in to Blue Access for Members

Understanding Provider Quality

We offer performance data and quality feedback for doctors, hospitals and more to help you make health care choices for you and your family. Be sure to follow your doctor's advice for getting care and check whether your plan covers those services and treatments.

If there is no performance data for a doctor or provider, that doesn’t mean that they’re not following the standards of care. There might not be a way to measure their performance yet, or maybe there isn't enough data to review.

Hospital Quality Measures – Process of Care Measures and Outcome of Care Measures

The Centers for Medicare and Medicaid Services (CMS) follows a standard set of performance measures for recommended hospital care for these 5 conditions:

  • Heart attack
  • Heart failure
  • Pneumonia
  • Surgical care improvement and infection prevention
  • Pediatric asthma

Hospitals are encouraged to report their quality of care information for these 5 medical conditions. Reporting is voluntary, but it’s linked to the payments hospitals get for treating Medicare patients.

Each hospital is given an overall score and detailed benchmark scores for each of the quality measures. The detailed benchmark scores include the national average hospital compliance and the top hospitals' compliance for each of the measures. (The top hospitals are the top 10% of hospitals nationwide.)

Process of care measures include quality measure sets for each of the conditions listed above.

Outcome of care measures are the 30-day rates for death and readmission to the hospital. They’re tracked for these categories:

  • Heart attack
  • Heart failure
  • Pneumonia

Blue Distinction Centers

Blue Distinction is a title given by the Blue Cross and Blue Shield companies to medical facilities that have shown expertise in delivering quality health care. The awarded title is based on strict, evidence-based selection guidelines chosen by leading medical specialists and professional organizations.

To earn this title, a facility's overall experience and total data must meet the criteria formed by expert clinicians and leading professional organizations.

Blue Distinction Centers+SM are hospitals recognized for their expertise and efficiency in providing specialty care. Quality is key: to become a Blue Distinction Center+, a facility must first meet all the quality requirements for a Blue Distinction Center before cost will be decided.

Learn more about Blue Distinction

BlueStar Hospitals

Blue Cross and Blue Shield of Illinois (BCBSIL) wants to help you make informed health care choices. The BlueStar Hospital Report gives you information about hospital performance. It can be used to help you choose the hospital that best meets your needs.

This report is based on the yearly BCBSIL Hospital Profile. It sums up the results of quality and safety performance measures for 91 urban Illinois hospitals.

Hospital profiles are made with the data from many sources, like:

  • BCBSIL claim data
  • An annual BCBSIL member survey
  • Information provided by the hospitals
  • Publicly available information from groups such as the Leapfrog Group, CMS and accrediting groups

For the Blue Star Hospital Report, each hospital's performance is reported for indicators in 6 categories:

  • Structure
  • Process
  • Outcomes
  • Patient experience
  • Efficiency
  • Informed decision-making

One blue star can be earned for each indicator, for a max of 10 blue stars.

Blue Star Medical Groups

The Blue Star Medical Group/IPA Report recognizes HMO contracting medical groups/Independent Practice Associations (IPAs) that have a record of high levels of performance in giving patient care. Each year, BCBSIL reviews medical group performance based upon national clinical practice and preventive care guidelines.

HMO members can use the Blue Star Medical Group/IPA Report to help them choose health care providers that best meet their needs.

Review the Blue Star Medical Group/IPA Report.

Leapfrog Hospital Surveys

The Leapfrog Group is made up of more than 160 companies and organizations. Together, they spend tens of billions of dollars on health care each year for more than 34 million Americans. This group has pointed out quality and safety practices that can improve patient safety at hospitals. In turn, hospitals voluntarily report on the steps they take to use these safety practices.


The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national, standardized survey. It’s sent to a random sample of hospital patients 18 years and older within 48 hours to 6 weeks after being released from the hospital. The survey includes 10 questions about a patients' view on important measures of care. The HCAHPS results can help you compare patients' experiences at different hospitals and against state and national benchmarks.

The survey includes information about these hospital patient experiences:

  • Communications with nurses and doctors
  • Responsiveness of hospital staff
  • Pain management
  • Communication about medicines
  • Discharge information

The survey also includes questions about:

  • Cleanliness of the hospital environment
  • Quietness of the hospital environment
  • Overall rating of the hospital
  • Their willingness to recommend the hospital

More information is available on the HCAHPS.

Last Updated: Oct. 18, 2023