Program Details

Name of Payment Reform Program
  Blue Distinction Centers for Specialty Care®
Organization Name
  Anthem Blue Cross and Blue Shield, sometimes referred to herein as Anthem National Accounts (ANA)
Program Contact Name
  Patricia Martin
Program Contact Title
  Director Specialty Network Management
Program Contact Email
Program Contact Phone
Program location(s)
  In this market and other markets
Market(s) (Ctrl-Click for multiple states)
  AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, DC, WV, WI, WY
Lines of business
  Self-insured commercial, Fully-insured commercial, Other
Other line of business
  The transplant COE benefit steerage program is available to both ASO and FI clients. The bariatric and orthopedic (2014) benefit steerage options are available only to ASO clients.
Stage of implementation
  Full implementation (e.g. available to all intended/applicable providers and members)
Payment reform model alignment
Other non-FSS based reform models
  Today, members are steered to high performing facilities for specialty care through benefit design and soft steerage. Benefit design steerage is available for bariatric surgery, transplants and (for 2014) spine surgery, knee/hip replacements. Members receive a higher benefit when using designated Blue Distinction facilities. Soft steerage is available for cardiac care, and complex/rare cancers.
Base payment methodology
Other base payment methodology
  Per Diem, DRG and some case rates methodologies may exist in each Plan's commercial agreement.
Participating provider types
  Hospital inpatient
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, 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)
Other performance measures
  Criteria are developed in collaboration with industry medical experts and clinicians including: • American College of Surgeons (ACS) • American Society for Metabolic and Bariatric Surgery (ASMBS) • American College of Cardiology (ACC) • National Comprehensive Cancer Network (NCCN) • Leapfrog Group • In 2013, cost criteria were added.
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, Other
Other features
  Benefit design steerage is available for bariatric surgery, transplants and spine surgery (2014), knee/hip replacements. Members receive a higher benefit when using designated BD facilities. Soft steerage is available for cardiac care and complex/rare cancers. A benefit steerage program is under consideration for cardiac care for 2015.
Information transparency
  We report to our network providers (e.g. hospitals and physicians)
Evaluation and results for program
  Program evaluation by external third party, Program evaluation by insurer, Other
Other evaluation methodology
  Please refer to Other Information document - Provider 7.