Health Care Value National Solutions

DSC_0093cHCV National Solutions is a collaborative effort to bridge BCBSM’s Value Partnerships programs with similar programs in Blue Cross and Blue Shield plans in other states. This presents a national network of all the clinical and value-based programs available to national customers.

 

 

Blue Distinction Specialty Care

Hospitals that have proven to have a distinctive level of outcomes, results and cost effectiveness in specific specialty areas can earn recognition from the Blue Cross and Blue Shield Association as Blue Distinction Centers.

The designation helps groups and individual members make decisions on where to go for certain procedures and care. Currently, the seven areas available for designation are:

This national BCBSA designation is based on objective, evidence-based selection criteria established in collaboration with expert physicians and medical organizations.

There are two levels of designation:

  • Blue Distinction Center – Facilities designated by BCBSA as Blue Distinction Centers (BDC) have demonstrated expertise in delivering quality healthcare for specific high-cost, high-variability services, measured by quality and patient safety measures, cost and network access.
  • Blue Distinction Centers+ – The “+” designation identifies facilities that are achieving the highest quality standards and are delivering it at benchmark performance on cost.

Blue Distinction Centers and Blue Distinction Centers+ demonstrate better quality and improved outcomes for patients, with lower rates of complications and re-admissions than their peers. For example, compared to non-BDC facilities:

  • Bariatric surgery results indicate a 31 percent lower 30-day major complication rate for primary gastric stapling.
  • Spine surgery results indicate a 38 percent lower readmission rate in the first 30 days after lumbar surgery.
  • Cardiac care results indicate a 20 percent better rate of complication avoidance following heart surgery.
  • Maternity care results indicate a 71 percent lower rate of early elective deliveries.

To find a Blue Distinction Center near you, use the Blue Distinction Center finder.

Source: Blue Cross Blue Shield Association

Blue Distinction Total Care

Blue Distinction Total Care is a way for quality and value programs in different Blues plans to integrate so that employers have access to similar quality programs when they have employees in multiple states.

Blue Distinction Total Care links Patient-Centered Medical Home and Accountable Care Organization programs through a platform of shared technology so that employers have seamless access to providers who deliver patient-centered, value-based care in multiple states.

Roughly 154,000 physicians – 85,000 primary care physicians and 68,000 specialty physicians – deliver patient-centered care to nearly 14 million Blue Cross and Blue Shield members nationally. There are more than 450 programs in the market today, across 43 states. These programs focus on shifting provider payment away from volume to value.

To be considered for BDTC designation, a provider must be part of a value-based program with a local Blue Plan that meets all six of the nationally required BDTC Program Selection Criteria. Blue Cross Blue Shield of Michigan health care professionals who participate in our Patient-Centered Medical Home and Organized Systems of Care programs are already classified as Blue Distinction Total Care providers since they meet these criteria for patient-centered, value-based reimbursement.

Criteria Definition
Patient-centered, Value-based Care Program focuses on managing care for a population of BCBS members.
Program attributes BCBS members to the Provider responsible for managing care.
Program provider contracts contain value-based incentives associated with both cost and quality outcomes.

Providers, in collaboration with BCBS Plans, are responsible for utilizing additional data and analytics to support activities including at least 3 of the following 5 practices to improve quality and affordability.

·       Practice Referral Pattern Management

·       Labs and Imaging Practice Management

·       Readmissions Practice Management

·       Medication Practice Management

·       Emergency Room Practice Management

Availability for BCBS Members Nationally Program is available to BCBS members through a PPO-based product.
Program is available to BCBS members covered by administrative services only (ASO) and fully insured products.

Blue Distinction Total Care is building upon impressive outcomes. Results based on local Plan analyses of individual programs have shown that Blue Distinction Total Care programs generate an average of $6 to $9 per attributed member per month in cost savings as well as a marked difference in key quality metrics (e.g., lower hospital and emergency department visits, increased number of breast cancer screenings).

Finding a BDTC doctor

To find a doctor with Blue Distinction Total Care designation use the Find a Doctor feature on bcbsm.com.