Matthew Schuller, project manager of accreditation and quality initiatives at the Blues, said Blue Distinction is a work in progress, and that the association is still committed to the program. Blues officials did not respond to requests for comment beyond that.
Blue Distinction aims to provide an unprecedented level of transparency on inpatient specialties to the 100 million consumers enrolled in Blues plans nationwide, the association said when unveiling the program.
Today, more than 780 hospitals nationwide have been named Blue Distinction Centers in four categories: cardiac care, bariatric surgery, organ transplants, and, as of last week, complex and rare cancers. A key goal of Blue Distinction is to promote better healthcare by expanding the number of providers delivering safe and effective care based on objective, evidence-based criteria, said the associations chief executive officer, Scott Serota, in a recent news release.
Some providers said Blue Distinction is a valuable addition to quality measures. Flowers Hospital in Dothan, Ala., has been a Blue Distinction Center in cardiac care for 18 months. Keith Granger, president and CEO of the 235-bed Flowers and chairman of the Alabama Hospital Association Quality Task Force, said because the Blues is the dominant private payer in the state, participation helps patients and employers. This is another affirmation and gives assurances to payers and patients about the high level of cardiac care available, he said.
He added that the state of Alabama doesnt have a quality reporting program, so providers look to payers and the CMS to get that recognition.
By contrast, in California, multiple health insurers as well as the state have quality recognition programs, so enthusiasm for Blue Distinction has been more tepid. UCSF Medical Center, San Francisco, is widely considered one of the top transplant centers in the state and the nation. But its not listed as a Blue Distinction Center because the hospital didnt apply. It would to a certain extent be duplicative of other distinction programs, said Reece Fawley, executive director of health plan strategy and revenue management for UCSF Medical Center.
Most health plans have had transplant center quality-distinction programs for at least 20 years, Fawley said. And 587-bed UCSF is already recognized by both Blue Cross of California and Blue Shield of California as a center of excellence and expertise in transplants.
Blue Distinction participation is tied to reimbursement rates, and UCSF has negotiated market-specific rates with the two Blues in that state. UCSF is a Blue Distinction center in bariatric surgery and complex and rare cancers, largely because there arent many quality rating programs for those specialties, Fawley said.
One California hospital that consistently rates well in cardiac care, Alta Bates Summit Medical Center with campuses in Oakland and Berkeley, applied to participate in the Blue Distinction cardiac-care program but was turned down by the association, a spokeswoman said. The hospital may reapply, she added.