Blue Distinction Centers+

Spine Surgery/ Knee and Hip Replacement

Elevator Speech

Blue Distinction® is awarded by Blue Cross and Blue Shield companies to recognize specialty medical facilities that deliver the highest quality health care. The Blue Distinction program has recently been updated tofocus on two criterions: quality and costof care. The medical facilities that meet the total value criteria will be recognized as Blue Distinction Centers+ (BDC+).

Due to increased pressure to rein in medical costs in the U.S. and customer requests, the Blue Cross and Blue Shield Association added cost criteria to the Blue Distinction program.The new criteria prompts specialty care providers to hold down costs, while still offering superior care.

The addition of the cost criteria will likely cause a number of Blue Distinction centers to lose their status, so the Blue Cross and Blue Shield Association established the quality-only designation to supportthe delivery of high quality care.

Current Blue Distinction Centers for Spine Surgery® and Blue Distinction Centers for Knee and Hip Replacement®have been evaluated on quality and cost. Those who meet the total-value (BDC+) and quality-only (BDC)criteria will be recognized with a national announcement from the Association inFebruary 2013.

Blue Cross and Blue Shield of North Carolina will recognize those facilities that have met the total-value (BDC+) designation only. In support of our commitment to help reduce costs BCBSNC will not recognize facilities who have met the quality only (BDC) requirements.

Key Messages

  • The Blue Cross and Blue Shield Associationrecently announced changes to the evaluation process for Blue Distinction Centers for Specialty Care® to include cost-of-care criteria.
  • The Blue Distinction Center+ program now recognizes facilities with the highest quality of care at the most competitive price.
  • The addition ofcost-of-care criteria to the Blue Distinction evaluation process will help consumers be more cost-conscious by bringing attention to medical facilities that offer more affordable, high quality care. Facilities that meet the criteria will be recognized as Blue Distinction Centers+.
  • Some current Blue Distinction Centers may not meet the Blue Distinction Center+ criteria and therefore will not be recognized as a BDC+.
  • Blue Distinction Centers for Spine Surgery® and Blue Distinction Centers for Knee and Hip Replacement® will be impacted at this time by the addition of cost-of-care criteria. Facilities in these groups that meet total value-based (BDC+) or quality-only(BDC) requirements will be announced by the Blue Cross Blue Shield Association in February 2013.
  • Spine Surgery, and Knee and Hip Replacement will be the first treatment categories impacted by the addition of the cost criteria.Four other programs – Cardiac Care, Transplants, Bariatric Surgery, and Complex and Rare Cancers – will add the cost criteria in 2013.
  • BCBSNC iscommitted to helping reduce the cost of health care without compromising quality. This change is an example of how BCBSNC is working to help rein in health care costs for its customers.
  • In support of our commitment to help reduce costs BCBSNC has elected to only recognize total-value (BDC+) facilities in NC and will not recognize facilities who have met the quality only (BDC) requirements.

National Accounts

  • BCBSNC will recognize total-value (BDC+) designations only; however, other Blue Cross and Blue Shield Plans may accept both the Blue Distinction Center and the Blue Distinction Center+ designations.
  • Some facilities may not meet the Blue Distinction Center+ criteria which include the new cost-of-care criteria, and in the Blue Cross and Blue Shield of North Carolina these facilities will lose their designation as a Blue Distinction Center, because North Carolina does not recognize quality only (BDC).
  • Facilities that meet total value-based (BDC+) or quality-only (BDC) requirements will be announced by the Blue Cross and Blue Shield Association in February 2013.
  • Nationally, more than 460 facilities are being recognized as Blue Distinction Centers+ for their expertise and cost efficiency in delivering specialty care.

Q&A

What is Blue Distinction?

Blue Distinction is a national designation program, set by the Blue Cross and Blue Shield Association, that recognizes facilities that demonstrate expertise in delivering quality specialty care safely, efficiently and cost effectively. There are currently six Blue Distinction designations: Spine Surgery, Knee and Hip Replacement, Cardiac Care, Transplants, Bariatric Surgery, and Complex and Rare Cancers.

The Blue Cross and Blue Shield Association created the Blue Distinctionprogram with two goals:

  • To encourage facilities and physicians to improve the overall quality and delivery of health care at the best price, resulting in better outcomes for patients.
  • To support consumers as they identify highquality and cost-effective medical facilities that best meet their specialty medical needs.

How is Blue Distinction evolving?

Blue Distinction now includes a value-based designation awarded to facilities that meet stringent quality measures, as well as cost-of-care criteria. This is known as the Blue Distinction Center+ (BDC+) designation. In addition, the Blue Cross and Blue Shield Association has created a quality-only designation to recognize facilities that offer superior quality care, but do not meet the cost-of-care criteria. This is known as the Blue Distinction Center (BDC) designation, which is not recognized by BCBSNC.

These new Blue Distinction Centers+ designations will help consumers find quality and affordability in their search for specialty-care doctors who practice at these facilities. They will alsoencouragehealthcare professionals to improve the overall quality and delivery of care, while holding down costs.

What changes are being made?

New cost criteria have been added to the Blue Distinction program to address market demand and customer request for more affordable healthcare.Only facilities that meet Blue Distinction’s quality criteria will be considered under the newly added cost criteria.The addition of the cost criteria has caused some Blue Distinction centers to lose their designation. In response to this, the Blue Cross and Blue Shield Association created a quality-only designation (BDC) that allows medical facilities to continue to be recognized for offering superior qualitymedical care. Blue Cross and Blue Shield of Carolina and Blue Cross and Blue Shield of Mississippi do not recognize the quality only (Blue Distinction Center) designation. Only the Blue Distinction Center+ is recognized by BCBSNC.

These changes in criteria will help customers make more informed health care decisionsby helping them find facilities that provide the highest quality and most cost-effective careoptions.

Why are these changes being made?

Due to increased pressure to rein in medical costs in the U.S., the Blue Cross and Blue Shield Association added the cost criteria to the Blue Distinction program. With the new criteria, the Blue Cross and Blue Shield Association is prompting specialty care facilities and physicians to hold down costs, while still offering superior care.

However, a number of Blue Distinction centers participating in the previous quality-based program do not meet the higher quality standards or the new cost criteria. Thus, the Blue Cross and Blue Shield Association created an additional quality only designation that uses the higher quality standards for the designation. This additional quality-only designation will include a broader list of facilities that meet the same selection criteria of quality status as the value-based designation, but did not meet the cost-of-care selection criteria. These designations of Blue Distinction Center+ and Blue Distinction Centers will help BCBSNC customers be more informed when looking for specialty care. Eligible North Carolina quality-only facilities were notified in November 2012 that BCBSNC will not be participating in the quality only designation. The Blue Distinction Centers+ will be announced in mid-February 2013.

BCBSNCis committed to helping its customers make more informed choices when seeking specialty medical treatment. Supporting the new Blue Distinction Center+designation will make it easier for customers to find more affordable, high quality care in North Carolina.

What centers will be affected by these changes?

The new total-value (BDC+) and quality-onlydesignations (BDC)will be phased in across all six Blue Distinction programs during 2012 and 2013, beginning with Blue Distinction Centers for Spine Surgery and Blue Distinction Centers for Knee and Hip Replacement. BCBSNC will continue to only recognize the BDC+ designation.

When will the changes be announced?

Spine surgery, and knee and hip replacement facilities that meet the new Blue Distinction Centers + designation criteria will be announced in February 2013.

Similar designation processes for Blue Distinction’s four other programs – Cardiac Care, Transplants, Bariatric Surgery, and Complex and Rare Cancers – will follow in 2013.

What is the timeline for this rollout?

BCBSNC invited eligibleSpine Surgery, and Knee and Hip Replacement facilities to apply for these two Blue Distinction designations in December 2011. Facilities completed the Request for Information (RFI) by Feb.14, 2012. Once evaluated using both the quality and cost-of-care criteria, new Blue Distinction Centers+ for Specialty Care will be announced in February 2013.

Will this lead to fewer Blue Distinction Centers for Specialty Care?

Yes. With more robust quality selection criteria and the addition of cost criteria, not all of the existing Blue Distinction Centers for Spine Surgery and the Blue Distinction Centers for Knee and Hip Replacement will be re-designated with the total-value (BDC+) designation. However, we do not anticipate a dramatic reduction in Blue Distinction centers with every future evaluation.

While the new total-value (BDC+) designation will lead to fewer Blue Distinction Centers for Spine Surgery® and Blue Distinction Centers for Knee and Hip Replacement®, specialty-care providers can still participate in the Blue Distinction program if their facility offers high quality care through a new quality-only designation, however these Blue Distinction Center designations will not be accepted by North Carolina and Mississippi. Created by the Blue Cross and Blue Shield Association, this additional designation will represent a broader list of facilities that meet the same selection criteria for quality as the total-value designation, but these facilities did not meet the cost-of-care criteria.

The new Blue Distinction Centers+ and the Blue Distinction Center designations will better inform health care consumers about facilities that deliver quality specialty care safely, efficiently and cost effectively.

If facilities lose their Blue Distinction designation, can they file an appeal?

If specialty-care facilities would like to appeal, they can submit a written appeal request within 30 days of the date that BCBSNC sends the Eligibility Notification Packet to their facility. Specialty care facilities should refer to the Appeal and Reconsideration Procedures document available on the BD Link Bulletin Board for more details.

Facilities should look for an upcoming request for information (RFIs) on other Blue Distinction Center+ designations, including Cardiac Care, Transplant, Bariatric Surgery, and Complex and Rare Cancers in 2013. BCBSNC will notify facilities when these dates are announced.

Could a facility keep its Blue Distinction designation in one specialty area, but lose its designation in another specialty area (e.g., under the total-value criteria, could a hospital keep its designation as a Blue Distinction Center for Spine Surgery, but lose its designation as a Blue Distinction Center for Knee and Hip Replacement)?

Yes. Each Blue Distinction designation has its own specific selection criteria, so a facility must apply separately and meet the selection criteria for each Blue Distinction program during each designation cycle.

What if a facility met the quality, but not the cost criteria? What options does the facility have?

Since the Blue Cross and Blue Shield Association began the value-based designation process, it added another quality-only designation. The additional designation will represent a broader list of national facilities that meet the same selection criteria for quality status as the total value-based designation, but did not meet the cost criteria. BCBSNC will not recognize the quality only Blue Distinction Center (BDC) designation. Eligible quality-only facilities were notified by BCBSNC and the Association in November 2012 that BCBSNC will not be recognizing quality only facilities. The total-value and quality-only designations will be announced in February 2013. Please note: quality-only designations (BDC) will not be announced for North Carolina.

Has Blue Distinction moved from being a more inclusive to a more selective designation?

Employersare asking for more options to help their employees find more affordable, high quality healthcare, especially for expensive specialty care. Blue Distinction seeks to identify and recognize facilities that deliver quality care safely, efficiently and more cost effectively.

We’ve responded to consumer and employer demands for greater emphasis on increased quality and affordability in specialty care, which has resulted in fewer Blue Distinction Center+ designations for Specialty Care.

Consumer and employer groups are always looking for ways to address rising healthcare costs. Did this influencethe addition of the cost-of-care criteria in Blue Distinction designations?

Strong market demand from both consumers and employer groups called for an evolution to the value-based designation. The Blue Cross and Blue Shield Association met these demands by enhancingBlue Distinction program to create anew designation, Blue Distinction Center+, that recognizes specialty care facilities for providinghigh quality care at a more affordable price.

In addition, the Blue Cross and Blue Shield Association has also created a quality-only designation to continue to support and recognize facilities that provide medical care of superior quality, however the Blue Distinction Center (BDC) designation of quality-only criteria will not be recognized in North Carolina.

Who determined these changes? Are there additional criteria being set by BCBSNC?

The Blue Cross and Blue Shield Association sets the guidelines and criteria for the Blue Distinction Centersfor specialty care. The Blue Cross and Blue Shield Association changed to program to include the total-value (BDC+) and the quality-only (BDC) designations. Additional criteria from BCBSNC require that all hospital-based physicians employed by the hospital are under contract with BCBSNC. The quality-only designation of Blue Distinction Center is not recognized in North Carolina.

What is the cost impact of this change to BCBSNC?

This change can help reduce the overall cost of health care for spine surgery, and knee and hip replacements by making consumers more aware of their health care spending.

If facilities do not meet the cost-of-care requirements but are still interested in achieving the Blue Distinction Center+ status, they may choose to restructure their costs, or make cost reductions and submit for reconsiderationof their Blue Distinction status. This may reduce what a patient pays at a facility.

Will these changes limit the choices for patients?

Certain employers offer health plans that require participating employees to pay a significantly higher cost share if they do not use Blue Distinction centers for their spine surgeries, and hip and knee replacements. Since BCBSNC does not recognize a quality-only Blue Distinction Center in North Carolina, these individuals must use a Blue Distinction Center+ to have a lower cost share for these surgeries. Individuals enrolled in these plans may have fewer Blue Distinction Center+ facilities located near them once the new cost criteria are in effect. These patients may need to travel further to a Blue Distinction Center+ facility for their surgery, or they may opt to pay more for a surgery at a nearby facility that is not a Blue Distinction Center+.

Willthe addition of the cost-of-care criteria affect the quality received in Blue Distinction Centers?

No, quality will continue to be the most important factor for determining which specialty care facilities receive Blue Distinction Center+ designation. The quality criteriais continually updated and increased on a prescribed basis.If Blue Distinction Centers+ for specialty care do not continue to improve quality while holding down costs, they can lose their BDC+ designation. If a facility does not pass the quality metrics, they are not passed on to the cost-criteria determination stage of the evaluation process.