A message from Michelle Fullerton, vice president, Market Insights & Care Management
Consider Centers of Excellence when referring patients for specialty care

Quality and cost variations are pervasive across the U.S. health care spectrum and continue to create challenges for members, group customers and health care providers alike.

In my current position, I work closely with our group customers, who provide health care for their employees and members — and who continually struggle to keep health care costs down. They also continually challenge Blue Cross Blue Shield of Michigan to do more to make health care more affordable.

One tool they use very effectively is Centers of Excellence. COEs are one strategy for steering employees to health care providers who practice efficiently at a high level of quality for reasonable, predictable prices. 

At Blue Cross, Blue Distinction^® Specialty Care is our COE program. The program includes nationally designated providers who show a commitment to delivering improved patient safety and better health outcomes, based on objective measures that were developed with input from leading accreditation and quality organizations. The Blue Cross Blue Shield Association leads the program, coordinating their efforts with local Blue plans, including Blue Cross Blue Shield of Michigan.

There are currently designated providers in 11 areas of specialty care:

• Bariatric Surgery
• Cancer Care
• Cardiac Care
• Cellular Immunotherapy – Car-T
• Fertility Care
• Gene Therapy
• Knee and Hip Replacement
• Maternity Care
• Spine Surgery
• Substance Use Treatment and Recovery
• Transplants

There are two distinct recognitions:

• Blue Distinction Center, which demonstrates quality care, treatment expertise and better overall patient results
• Blue Distinction Centers+, which demonstrates more affordable care in addition to quality care, treatment expertise and better overall patient results

These designations are not only important for our group customers but also to primary care physicians who need to refer their patients for specialty care. As Alina Pabin, director of National Networks and Programs, recently pointed out, “Navigating health care and selecting a doctor or hospital can be daunting for patients — and sometimes a challenge for primary care doctors who are trying to help their patients find an appropriate location for specialty care. Centers of Excellence designation programs like Blue Distinction Specialty Care reduce the burden of researching and assessing provider performance and help people find high-quality care in their communities.”

Other quality efforts and designations
In addition to these Centers of Excellence, Blue Cross Blue Shield of Michigan has developed numerous programs that support and encourage the delivery of high-quality care. For example:

• Our Spine and Joint Care Program designates high-performing providers and facilities both in Michigan and outside of the state. Applicable providers include physician practices in Michigan that perform musculoskeletal procedures, including total hip or knee joint replacement, spinal fusion (both cervical and lumbar) and spinal decompression. Practices must meet volume and cost criteria for select MSK episodes of care and be engaged in our Collaborative Quality Initiatives.
  
  For more information or a list of providers who are currently in the program, send an email to provcomm@bcbsm.com.

• Our Collaborative Quality Initiatives address some of the most common and costly areas of surgical and medical care, including bariatric surgery, knee and hip replacement, obstetrics and spine surgery. We currently have 23 CQIs. For more information, visit the Collaborative Quality Initiatives section of valuepartnerships.com or contact the CQI Administration Team at CQIPrograms@bcbsm.com.

I encourage health care providers to consider the Blue Distinction Specialty Care program when referring patients for specialty care. I also encourage providers to participate in CQIs that relate to their areas of expertise.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.