Program Details

Name of Payment Reform Program
  Bariatric Surgery PPO Narrow Network for 9 counties in southern CA (surgeons and hospitals) Jim Orchison 415-229-5157
Organization Name
  California Physician's Service, DBA Blue Shield of California
Program Contact Name
  Jim Orchison
Program Contact Title
  Director, Network Designs & Programs
Program Contact Email
Program Contact Phone
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
Lines of business
  Self-insured commercial, Fully-insured commercial
Stage of implementation
  Full implementation (e.g. available to all intended/applicable providers and members)
Date of Implementation
  January 1, 2007
Payment reform model alignment
  Shared-risk (other than bundled payment) and/or gainsharing with quality
Base payment methodology
Other base payment methodology
  Narrow network
Participating provider types
Other types of providers
  Surgeons and hospitals
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  Healthcare acquired conditions (HACs) also known as hospital-acquired conditions, Serious Reportable Events (SREs) that are not HACs, Never Events
Performance measures used
  Achievement (relative to target or peers) of Clinical process goals (e.g., prophylactic antibiotic administration, timeliness of medication administration, testing, screenings), Improvement over time of NQF-endorsed Outcomes and/or Process measures, PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues), Longitudinal efficiency relative to target or peers, Patient experience, Health IT adoption or use, Utilization results
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  Mandatory use of Centers of Excellence (COE) or higher performing providers, Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers
Information transparency
  We report to the general public, We report to our network providers (e.g. hospitals and physicians), We report to patients of our network providers
Evaluation and results for program
  Program evaluation by external third party, Program evaluation by insurer