Find more information about how we choose the doctors, hospitals and healthcare professionals for our HMO networks here.
Blue Care Network has a variety of HMO networks in Michigan. Our Blue Cross Preferred network covers the entire state. Our other HMO networks, including Blue Cross Select and Metro Detroit HMO are available in select counties. These networks are subsets of the Blue Cross Preferred network and are often referred to as value networks. They offer additional cost savings while maintaining quality of care. All our HMO networks are available in bronze, silver and gold tier plans.
We evaluate provider performance by analyzing data across four healthcare areas. Learn how we evaluate provider performance.
Select an HMO network to learn more about how we select physicians, hospitals and other providers for each network.
Doctors and hospitals in our Blue Cross Preferred network have to meet strict standards:
Doctors:
Hospitals:
The Blue Cross Select network gives members a lower-cost option. This network has primary care physicians, or PCPs, in 31 counties that meet minimum standards for cost and quality measures.
Members who live in these counties can choose this plan:
Doctors and hospitals in the Blue Cross Select network are also part of our statewide Preferred network. Blue Cross Select providers must meet additional requirements to take part in this value network.
Blue Cross Select providers meet quality standards set by the National Committee for Quality Assurance and the National Quality Forum. These standards include quality scores based on Healthcare Effectiveness Data and Information Set (HEDIS) measures, such as offering immunizations and cancer screenings.
After we make sure that providers meet these quality standards we look at the total cost of care for their patients. This includes physician, hospital and pharmacy costs for members. We then include only providers with the lowest costs, which is about the top 70 percent.
The Blue Cross Local HMO network is designed to provide comprehensive and affordable healthcare for individuals and families in Wayne, Oakland and Macomb counties with Silver and Bronze plan options.
These plans connect you with a robust network — including over 1,000 primary care providers and 15 hospitals, featuring trusted systems like Henry Ford Health, Ascension and Trinity. Your primary care provider, or PCP, will be your main partner in health, coordinating all aspects of your treatment and referring you to specialists as needed.
When you seek care within the Local HMO network, you are assured access to high-quality doctors and facilities, but services performed outside of this network require both PCP and plan authorization. Except for emergency services and accidental injuries, care outside the network is not covered, ensuring you receive care where quality and cost controls are highest.
If you travel within Michigan and need urgent medical attention, coverage is provided for emergencies and accidental injuries at out-of-network hospitals. By keeping your healthcare local and coordinated, the Local HMO network aims to offer both personalized service and peace of mind, simplifying your access to care and helping you make the most of your health plan benefits.
In addition to the specific criteria that providers must meet to belong to our networks, we monitor other factors. Read how we make sure members have sufficient access to care and the types of providers in our networks.
We make sure that members have access to care within a reasonable distance to their home. We use standards that include travel time or distance.
We regularly monitor access to primary care providers, specialists, ancillary providers and facilities. If necessary, additional providers that meet our credentialing and network requirements may be added. This is how we make sure members have proper access to care.
At least 90 percent of our member population has to have access to a certain number of providers within a certain travel time or distance from their home, no matter where they live. The standard varies by specialty and type of area. For example, in a large metro area, members must have at least one primary care provider within 10 minutes or five miles from their home. In a rural area, the access standard for primary care providers is 40 minutes or 30 miles.
Read about our access standards (PDF) for primary care providers, specialists and hospitals in each area type.
Ancillary and Allied Providers and Facilities
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