Highmark Inc. has unveiled a new group health plan that provides incentives for members to use providers that exhibit higher quality outcomes, fewer complications and reduced readmissions.
Called Blue Distinction Benefits, the group offering encourages members to use Blue Distinction Centers, a listing compiled by the BlueCross BlueShield Association of providers across the country who meet quality criteria in six separate high-cost, high-risk areas of specialty care.
"Blue Distinction Benefits offers group customers the ability to drive members to proven high-quality providers while controlling costs," said Steven Nelson, senior vice president of health services strategy, product and marketing at Highmark in a press release announcing the new health plan. "Because these specialty services are such high cost, if employers can encourage the use of proven, quality facilities, then we anticipate that better outcomes and ultimately, lower rates will follow."
The Blue Distinction designation focuses on patient safety and outcomes in six specialty areas including bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery and transplants. According to the BlueCross BlueShield Association, treatments of these conditions account for roughly 30 percent of all hospital inpatient costs.
To help determine the criteria for choosing Blue Distinction Centers, BCBS conducts both an examination of established national standards of care for a particular specialty area while also consulting with experts at related physician and medical organizations. For instance, for hip and knee replacements, BCBS consults with both the American Academy of Orthopaedic Surgeons (AAOS) and American Board of Orthopaedic Surgeons (ABOS).
Providers with Blue Distinction recognition are located across the country and are listed separately under each of the six specialty areas where they have met the selection criteria. Providers typically need to renew their application to the program every 18 to 36 months by providing their clinical data in order to allow BCBS to determine if the quality of care has been maintained or quality thresholds need to be raised to reflect recent improvements in care.
Under the new plan provided by Highmark, employers looking to lower overall costs through the program can select from three cost-sharing options, each designed to encourage the use of Blue Distinction Centers and discourage the use of other providers.
The cost sharing options are:
- Decreased member cost sharing such as waived deductibles and/or coinsurance/copays for members who utilize a Blue Distinction Center to receive specialty care;
- Additional copays for members who utilize a non-Blue Distinction Center to receive specialty care; or
- No coverage for members who do not utilize a Blue Distinction Center to receive specialty care.
Members of these plans can use Highmark's online provider search tool to locate the nearest Blue Distinction Center near them.
[See also: The Glass Hospital: Transparency in quality for a consumer-driven healthcare system]