Clinical Quality Initiative Program


The Clinical Quality Initiative, or CLQI, aims to improve the quality health care delivered by PGIP participating physicians by rewarding physician organizations, or POs, that support population-wide adoption and implementation of evidence-based medical guidelines into their daily practice. The CLQI consist of selected Health Effectiveness Data and Information Set (HEDIS) and Centers for Medicare & Medicaid services star measures to compare performance of PGIP physician organizations.

To achieve success in CLQI, POs and Providers need to do the following:

  • Identify opportunities for improvement in measures by conduction of data analysis and continuous quality improvement processes.
  • Induce and deploy best practices among their physician communities that results in safe and effective care.
  • Support innovation and constructive change in processes for the delivery of care.
  • Promote better outcomes and coordination of care across provider settings.
  • Develop and implement strategies for population health management.

Data Deliveries

  • We receive and review data distributed by BCBSM by identifying practice units that represent opportunity for improvement.
  • We utilize prospective data reports, dashboards, and quality scorecards.
  • We develop and implement intervention plans such as trend reports to improve HEDIS performance.

Measures tied to payment

  • Through participation in this initiative, POs are rewarded for their performance in the CLQI for BCBScommercial and MA Member populations.
  • Each HEDIS/Pharmacy measure will be scored individually and if the PO meets the 75th or 90th percentile benchmark for individual measures, payments are earned for every compliant member.

Physician Organizations are automatically enrolled in this initiative

For more information, contact BACO Transformation Coordinator and initiative lead, Felicia Brown at

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