Transcript National Labor Office Staff

A Blue Cross and Blue Shield Association Presentation
Quality in Practice:
The BCBS Blue Distinction® Program
Iowa Health Buyers Alliance Annual Conference
Robert Krause, Director
National Labor Office
Blue Cross and Blue Shield Association
Blue Cross and Blue Shield Association
 A national federation of 39 independent, communitybased and locally operated Blue Cross and Blue Shield
companies
 Collectively we provide healthcare coverage for more
than 102 million individuals – 1 in 3 Americans
 For more information, visit www.BCBS.com
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Mission
The mission of the National Labor Office (NLO) is
to position the Blues as Labor’s healthcare
partner of choice.
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Mission
 Marketing tools
 Database
 Education
 Conferences
 New healthcare products
Affordable and accessible healthcare
Plans
Organized Labor
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Our Charge
The National Labor Office represents the Blue
Cross and Blue Shield System with organized
labor for the ultimate purpose of acquiring and
retaining contracts for Blue Cross and Blue
Shield Plans
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NLO Sponsor Plans – Voluntary
• Arkansas BCBS
• Excellus BCBS
• Alabama BCBS
• Western New York BCBS
• BS of California
• CareFirst BCBS
• Anthem/Wellpoint, Inc.(14 states)
– Empire BC – East Region
– BC of California – West Region
• Horizon BCBS
• BCBS of Delaware
• Capital BC
• BCBS of Florida
• Independence BC
• BCBS of Illinois
• Highmark BCBS
• BCBS of Massachusetts
• BCBS of Rhode Island
• BCBS of Michigan
• BCBS of South Carolina
• BCBS of Minnesota
• BCBS of Tennessee
• BCBS of Montana
• Mountain State BCBS
• BCBS of Nebraska
• HMSA - Hawaii
• Premera Blue Cross
• BCBS of Oklahoma
• Wellmark BCBS
• Regence BCBS
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NLO Governance Structure
NLO
Board of Directors
Executive
Committee
Labor Advisory Committee
(including LAC Liaison to the Board)
Early Retiree/VEBA
Education
and Training
Revenue
National Labor
College
Blue Labor Basics
Strategic
Alliance
Market
Research
Distribution
Channel/Partners
Labor
Prospects
Plan Market
Survey
Labor
Certification Program
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Blue Assets and Programs
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Blue Assets and Programs:
Maximizing the Value of Your Customer’s Healthcare Dollar
Your Customer’s Critical
Healthcare Needs
The Strength
that The Blues® Deliver
• Target healthcare dollars

• Better overall health outcomes
and quantifiably lower costs

• Increasing member health
engagement at the worksite

®
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Better Outcomes and
Better Value for Specialty Care
®
Quality-based designation for facilities with better overall
outcomes for high cost, high variability health conditions
• Evidence-based selection criteria developed in collaboration with expert
clinicians and leading professional organizations
• Broad, inclusive scope allows quality choices in four specialties for your
members nationwide (with more coming)
• Simplified member-directed access minimizes need for employer
involvement
• Results in quantifiably better overall health outcomes and lower costs
• Provides a quality-based, cost-effective means for flexible benefit
design
Note: Designation as Blue Distinction Centers means that these facilities’ overall experience and aggregate data met objective criteria established in
collaboration with expert clinicians’ and leading professional organizations’ recommendations. Individual outcomes may vary.
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Better Outcomes and
Better Value for Specialty Care
®
Evidence-based selection criteria developed in collaboration
with expert clinicians and leading professional organizations
Bariatric Surgery
Cardiac Care
• American Society for Metabolic &
Bariatric Surgery (ASMBS)
• American College of Cardiology (ACC)
• Surgical Review Corporation (SRC)
• Society of Thoracic Surgeons (STS)
Complex & Rare Cancers
• National Comprehensive Cancer
Network (NCCN)
Transplants
• Center for International Blood and Marrow
Transplant Research (CIBMTR)
• Scientific Registry of Transplant
Recipients (SRTR)
• Foundation for the Accreditation of
Cellular Therapy (FACT)
Criteria are transparent, available to the public on BCBS.com
These organizations have provided information and input, but do not formally endorse the Blue Distinction Centers program.
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Better Outcomes and
Better Value for Specialty Care
®
Broad, inclusive scope allows quality choices in four
specialties for your members nationwide
More than 800 Designations across 45 states
Blue Distinction Centers
for Cardiac Care®
WA
VT
ND
MT
MI
WY
IA
NE
NV
UT
NY
WI
SD
ID
CA
NH
MN
OR
Blue Distinction Centers
for Bariatric Surgery®
CO
IL
KS
PA
OH
IN
WV VA
Blue Distinction Centers
for Transplants®
OK
NM
NC
SC
AR
AL
GA
MS
TX
LA
FL
AK
Blue Distinction Centers
Complex and
Rare CancersSM
MA
RI
CT
NJ
DE
MD
KY
MO
TN
AZ
ME
HI
PR
We will expand specialty areas and increase
the number of Blue Distinction designated facilities
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Better Outcomes and
Better Value for Specialty Care
®
Simplified member-directed access minimizes need for
employer involvement
members can easily
learn more about
Blue Distinction with
a click of a mouse
Memorial Hospital
324 W. Main
Southpaw, MI 32012
(313) 777-6329
St. Joseph’s Hospital
National Doctor &
Hospital Finder
enables hospital
comparisons based
on Blue Distinction
status
123 Beach St.
Lakeview, MI 32779
(313) 777-1234
Lake County Medical Center
5734 First Ave.
Quinipshaw, MI 32968
(313) 723-5681
North Central Hospital
1 North Central Blvd.
Pikesville, MI 32553
(316) 878-5885
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Better Outcomes and
Better Value for Specialty Care
®
Results in quantifiably better overall health outcomes…
Cumulative Readmissions
(0-90 Days)
5%
11%
10.9%
10.5%
10.4%
9.5%
Coronary Artery Bypass Graft
Angioplasty
(CABG)
(PCI)
BDC
Source: Based on claims data from BlueCross BlueShield Plans in eleven states
Other
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Better Outcomes and
Better Value for Specialty Care
®
... and quantifiably lower costs
Average Cost
Savings per Procedure(1)
Average Number
of Procedures per Year(2)
(per 90-day episode)
(per 5,000 member group)
Procedure: CABG
$7,893
BDC
x
8.3
=
$65,512
x
21.6
=
$30,996
Other
Procedure: Angioplasty
$1,435
BDC
Potential Savings
per Year
Other
Assumes members are not currently utilizing Blue Distinction Centers for these procedures.
Source: (1) Based on claims data from BlueCross BlueShield Plans in eleven states, based on 90-day episode
(2 ) American Heart Association: Heart Disease and Stroke Statistics—2008 Update
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Better Outcomes and
Better Value for Specialty Care
®
Provides a quality-based, cost-effective means for flexible
benefit design
• National employers using and promoting Blue Distinction for
member education and highlighting facilities offering better
overall outcomes
• Others developing differential benefit designs to encourage or
require use of Blue Distinction Centers
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Better Outcomes and
Better Value for Specialty Care
®
Provides a quality-based, cost-effective means for flexible
benefit design
• Example of Benefit Design driven by Blue Distinction
• 52,000 members
• 2,500 branch offices across 24 states
• Tailored benefit design to compensate for bariatric surgery only at Blue
Distinction Centers, added supporting travel benefit
• Effectively steered members to higher quality care
…[BCBS] established bariatric centers of excellence. That’s helped us from the
standpoint of making sure it’s a high quality service that’s provided."
– Bruce Wilson
Senior Vice President, Compensation and Benefits
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Better Outcomes and
Better Value for Specialty Care
®
ABC Manufacturing
• High incidence of cardiac care need in SIC
classification, particularly among older,
male workers in Upper Midwest
• BCBS aggregate claims data triggers
targeted education materials and
resources to at-risk worksites
– Biometric screenings
– Health fairs/ workshops
– Distribution of Blue Distinction Provider
Directory
• Members who require specialty care and
select Blue Distinction facilities experience
better overall outcomes, with fewer
complications and lower overall costs
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Blue Assets and Programs:
Maximizing the Value of Your Customer’s Healthcare Dollar
Your Customer’s Critical
Healthcare Needs
The Strength
that The Blues® Deliver
• Target healthcare dollars

• Better overall health outcomes
and quantifiably lower costs

• Increasing member health
engagement at the worksite

®
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Questions??
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