Blue Distinction BCBSA National Initiative for Specialty Care

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Blue Distinction BCBSA National Initiative for
Specialty Care
Donald R. Fischer, MD, MBA Senior Vice President
for Integrated Clinical Services Chief Medical
Officer Highmark BCBS July 25, 2007
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Blue Distinction
Blue Distinction
What is Blue Distinction?

• Blue Distinction is the BCBS companies
  nationwide program that will create an
  unprecedented level of transparency with two
  goals
• Engaging consumers to enable more informed
  healthcare decisions
• Collaborating with providers to improve quality
  outcomes and affordability

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Blue Distinction

• Recognizing Excellent Facilities
• Blue Distinction Centers for Transplant
• Blue Distinction Centers for Bariatric Surgery
• Blue Distinction Centers for Cardiac Care
• Blue Distinction Centers for Oncology Care
• Hospital Quality Program
• Optimizing Collaborative Programs
• BCBS Platform Physicians Quality and
  Affordability Measurement
• Quality Improvement Programs
• Medical Societies and Boards - ABIM / ACP / ACC
• Bridges to Excellence
• NCQA Certification
• Blue Health Intelligence
• Multi-Plan National Data Warehouse

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Blue Distinction Network

• What is Blue Distinction?
• Blue Distinction Centers for Specialty Care
• are a national network of recognized specialty
  centers
• developed in collaboration with BCBS Association
  and other BCBS Plans.

• Cardiac

• Bariatric

• Transplant

• Cancer

• Specialized case management
• National network including additional transplant
  centers designated as Anthem Centers of Medical
  Excellence (CME)
• Quality, evidence-based performance criteria for
  both BDC and CME designations

• Referral centers that specialize in rare and
  complex advance cancers
• Demonstrated expertise and comprehensive care
• Will include NCI designated cancer centers, NCCN
  cancer programs and hospitals selected through an
  RFI process

• Full range of cardiac services required
• Full accreditation by JCAHO or HFAP
• Demonstrable outcomes
• Minimum number of catheterizations, bypass and
  valve surgeries performed each year

• Must have performed more than 100 surgical cases
  per year actively performing bariatric surgery
  cases for the most recent 24 month period
• One month survival post-surgery of at least 99
• Multi-disciplinary team approach

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Blue Distinction Centers for Cardiac Care

• Cardiac centers are required to
• Provide a full range of cardiac services
  including inpatient cardiac care, inpatient and
  outpatient cardiac rehabilitation, cardiac
  catheterization including percutaneous coronary
  interventions (PCI) and cardiac surgery including
  coronary artery bypass graft surgery (CABG)
• Perform a minimum number of PCI per year
• Perform a minimum number of adult cardiac
  surgical procedures (including both CABG and/or
  valve surgery) per year
• Be fully accredited by the Joint Commission for
  Accreditation of Healthcare Organizations (JCAHO)
  or Healthcare Facilities Accreditation Program
  (HFAP)

Cardiac centers will be required to
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Blue Distinction Centers for Cardiac Care

• The Cardiac Center RFI includes not only volume
  and accreditation requirements, but also measures
  the hospitals success in nationally recognized
  interventions and outcomes.
• Patient Instructions
• Medication Administration
• Left Ventricular Functional Assessment Timing
• Mortality
• Complication Rates

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Blue Distinction CentersCardiac Care
Blue Distinction Centers for Cardiac Care
WA
ME
VT
ND
MT
NH
MN
OR
NY
MA
WI
SD
ID
RI
MI
WY
CT
PA
IA
NJ
NE
IN
OH
DE
NV
IL
WV
MD
UT
VA
CO
KS
KY
MO
CA
NC
TN
OK
SC
AZ
NM
AR
AL
GA
MS
TX
LA
FL
AK
HI
PR
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Blue Distinction CentersCardiac Care
Blue Distinction Centers for Cardiac Care

• Blue Distinction criteria lead to demonstrably
  better and more consistent outcomes at qualifying
  centers

Inpatient Mortality(Heart Attack)
Variability from outliers And small volume centers
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Blue Distinction Centers for Bariatric Surgery

• The Bariatric application includes similar
  requirements as the Cardiac program, tailored to
  the patients condition
• Duration of program, volume of procedures
• Full service hospital offering ER and ICU care
• Individual physician credential evaluation
• Policies should be in accordance with ASBS, ACS,
  ACOS, or CMS consensus guidelines

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Blue Distinction Centers for Bariatric Surgery

• Hospital Interventions, Outcomes, and
  Capabilities
• Dedicated behavioral health, nurse/ physician
  extenders and dietitians/nutrition professionals
• Appropriateness and capacity of hospital
  equipment
• Post-discharge follow-up at one year
• Mortality
• Complication Rates

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Blue Distinction Centers for Bariatric Surgery
WA
ME
VT
ND
MT
NH
MN
OR
NY
MA
WI
SD
ID
RI
MI
WY
CT
PA
IA
NJ
NE
IN
OH
DE
NV
IL
WV
MD
UT
VA
CO
KS
KY
MO
CA
NC
TN
OK
SC
AZ
AR
NM
AL
GA
MS
TX
LA
FL
AK
HI
PR
States with participating BCBS Plans by end of
2006 (not all participating regions have eligible
centers)
In discussion for future participation
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Blue Distinction Centers
Blue Distinction Centers for Transplants
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Blue Distinction Centers

• Blue Distinction criteria lead to demonstrably
  better and more consistent outcomes at qualifying
  transplant centers

Transplant Patient Survival Rate(One-Year Heart
Transplant)
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Hospital Performance Measurements

• Objectives
• Provide data and information to help hospitals
  across the nation consistently deliver quality
  care
• Share meaningful information with national
  account employers to make better informed benefit
  decisions.
• Enhance the value of the Blue national networks
  by reporting on a standard set of hospital
  quality performance measures.

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Hospital Performance Measurements
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Provider Measurement Improvement
Hospital Performance MeasurementsParticipating
Plans
WA
ME
VT
Features
MT
ND
NH
MN
OR
NY
MA
WI
SD
ID

• National framework for improving care delivery
• Integrates provider performance metrics from
  public sources
• Associated with ongoingquality / performance
  improvement initiatives
• Dialogue
• Incentives / P4P

RI
MI
WY
PA
CT
IA
NJ
NE
OH
IN
DE
NV
IL
WV
MD
UT
CO
VA
MO
KY
KS
CA
NC
TN
OK
SC
AZ
AR
NM
AL
GA
MS
TX
LA
FL
AK
PR
HI
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Blue Distinction
Blue Distinction
Summary

• Fosters Transparency for Quality
• Provides guidance for choosing an excellent
  facility
• for certain conditions
• Transplant
• Cardiac
• Bariatric Surgery
• Oncology (on deck)
• Outcomes for Cardiac and Transplant proven to be
• superior
• Broad general networks still are desirable and
  remain
• a strategic advantage for the Blues