Quality in Practice: The BCBS Blue Distinction

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Quality in Practice The BCBS Blue Distinction
ProgramIowa Health Buyers Alliance Annual
Conference

• Robert Krause, Director
• National Labor Office
• Blue Cross and Blue Shield Association

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Blue Cross and Blue Shield Association

• A national federation of 39 independent,
  community-based and locally operated Blue Cross
  and Blue Shield companies
• Collectively we provide healthcare coverage
  for more than 102 million individuals 1 in 3
  Americans
• For more information, visit www.BCBS.com

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Mission
The mission of the National Labor Office (NLO)
is to position the Blues as Labors healthcare
partner of choice.
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Mission

• Marketing tools
• Database
• Education
• Conferences
• New healthcare products

Affordable and accessible healthcare
Plans
Organized Labor
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Our Charge
The National Labor Office represents the Blue
Cross and Blue Shield System with organized labor
for the ultimate purpose of acquiring and
retaining contracts for Blue Cross and Blue
Shield Plans
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NLO Sponsor Plans Voluntary

• Arkansas BCBS
• Alabama BCBS
• BS of California
• Anthem/Wellpoint, Inc.(14 states)
• Empire BC East Region
• BC of California West Region
• BCBS of Delaware
• BCBS of Florida
• BCBS of Illinois
• BCBS of Massachusetts
• BCBS of Michigan
• BCBS of Minnesota
• BCBS of Montana
• BCBS of Nebraska
• Wellmark BCBS
• Regence BCBS

• Excellus BCBS
• Western New York BCBS
• CareFirst BCBS
• Horizon BCBS
• Premera Blue Cross
• BCBS of Oklahoma
• Capital BC
• Independence BC
• Highmark BCBS
• BCBS of Rhode Island
• BCBS of South Carolina
• BCBS of Tennessee
• Mountain State BCBS
• HMSA - Hawaii

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NLO Governance Structure
NLO Board of Directors
ExecutiveCommittee
Labor Advisory Committee(including LAC Liaison
to the Board)
Market Research
Distribution Channel/Partners
Educationand Training
StrategicAlliance
Early Retiree/VEBA
Revenue

Labor Prospects
National LaborCollege
Plan Market Survey
Blue Labor Basics
LaborCertification Program
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Blue Assets and Programs
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Blue Assets and Programs Maximizing the Value
of Your Customers Healthcare Dollar
Your Customers Critical Healthcare Needs
The Strength that The Blues Deliver

• Target healthcare dollars
• Better overall health outcomes and quantifiably
  lower costs
• Increasing member health engagement at the
  worksite

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Better Outcomes and Better Value for Specialty
Care
Quality-based designation for facilities with
better overall outcomes for high cost, high
variability health conditions

• Evidence-based selection criteria developed in
  collaboration with expert clinicians and leading
  professional organizations
• Broad, inclusive scope allows quality choices in
  four specialties for your members nationwide
  (with more coming)
• Simplified member-directed access minimizes need
  for employer involvement
• Results in quantifiably better overall health
  outcomes and lower costs
• Provides a quality-based, cost-effective means
  for flexible benefit design

Note Designation as Blue Distinction Centers
means that these facilities overall experience
and aggregate data met objective criteria
established in collaboration with expert
clinicians and leading professional
organizations recommendations. Individual
outcomes may vary.
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Better Outcomes and Better Value for Specialty
Care
Evidence-based selection criteria developed in
collaboration with expert clinicians and leading
professional organizations
Bariatric Surgery
Cardiac Care

• American Society for Metabolic Bariatric
  Surgery (ASMBS)
• Surgical Review Corporation (SRC)

• American College of Cardiology (ACC)
• Society of Thoracic Surgeons (STS)

Complex Rare Cancers
Transplants

• Center for International Blood and Marrow
  Transplant Research (CIBMTR)
• Scientific Registry of Transplant Recipients
  (SRTR)
• Foundation for the Accreditation of Cellular
  Therapy (FACT)

• National Comprehensive Cancer Network (NCCN)

Criteria are transparent, available to the public
on BCBS.com
These organizations have provided information and
input, but do not formally endorse the Blue
Distinction Centers program.
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Better Outcomes and Better Value for Specialty
Care
Broad, inclusive scope allows quality choices in
four specialties for your members nationwide
More than 800 Designations across 45 states
We will expand specialty areas and increase the
number of Blue Distinction designated facilities
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Better Outcomes and Better Value for Specialty
Care
Simplified member-directed access minimizes need
for employer involvement
members can easily learn more about Blue
Distinction with a click of a mouse
Memorial Hospital 324 W. Main Southpaw, MI
32012 [phone]
DRAFT
St. Josephs Hospital 123 Beach St. Lakeview, MI
32779 [phone]
National Doctor Hospital Finder enables
hospital comparisons based on Blue Distinction
status
Lake County Medical Center 5734 First
Ave. Quinipshaw, MI 32968 [phone]
North Central Hospital 1 North Central
Blvd. Pikesville, MI 32553 [phone]
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Better Outcomes and Better Value for Specialty
Care
Results in quantifiably better overall health
outcomes
Cumulative Readmissions(0-90 Days)
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Coronary Artery Bypass Graft
Angioplasty
(CABG)
(PCI)
BDC
Other
Source Based on claims data from BlueCross
BlueShield Plans in eleven states
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Better Outcomes and Better Value for Specialty
Care
... and quantifiably lower costs
Average CostSavings per Procedure(1)(per 90-day
episode)
Potential Savingsper Year
Average Numberof Procedures per Year(2)(per
5,000 member group)
65,512
Procedure CABG
8.3
x
7,893

30,996
Procedure Angioplasty
21.6
x

1,435
Assumes members are not currently utilizing Blue
Distinction Centers for these procedures.
Source (1) Based on claims data from BlueCross
BlueShield Plans in eleven states, based on
90-day episode (2 ) American Heart
Association Heart Disease and Stroke
Statistics2008 Update
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Better Outcomes and Better Value for Specialty
Care
Provides a quality-based, cost-effective means
for flexible benefit design

• National employers using and promoting Blue
  Distinction for member education and highlighting
  facilities offering better overall outcomes
• Others developing differential benefit designs to
  encourage or require use of Blue Distinction
  Centers

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Better Outcomes and Better Value for Specialty
Care
Provides a quality-based, cost-effective means
for flexible benefit design

• Example of Benefit Design driven by Blue
  Distinction

• 52,000 members
• 2,500 branch offices across 24 states
• Tailored benefit design to compensate for
  bariatric surgery only at Blue Distinction
  Centers, added supporting travel benefit
• Effectively steered members to higher quality care

BCBS established bariatric centers of
excellence. Thats helped us from the standpoint
of making sure its a high quality service thats
provided." Bruce Wilson Senior Vice
President, Compensation and Benefits
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Better Outcomes and Better Value for Specialty
Care
ABC Manufacturing

• High incidence of cardiac care need in SIC
  classification, particularly among older, male
  workers in Upper Midwest
• BCBS aggregate claims data triggers targeted
  education materials and resources to at-risk
  worksites
• Biometric screenings
• Health fairs/ workshops
• Distribution of Blue Distinction Provider
  Directory
• Members who require specialty care and select
  Blue Distinction facilities experience better
  overall outcomes, with fewer complications and
  lower overall costs

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Blue Assets and Programs Maximizing the Value
of Your Customers Healthcare Dollar
Your Customers Critical Healthcare Needs
The Strength that The Blues Deliver

• Target healthcare dollars
• Better overall health outcomes and quantifiably
  lower costs
• Increasing member health engagement at the
  worksite

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• Questions??