Blue Distinction: For Providers
Blue Distinction® is a designation awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare, under objective selection criteria. The designation is based on rigorous, evidence-based selection criteria established in collaboration with expert physicians' and medical organizations' recommendations. Its goal is to help consumers find quality specialty care on a consistent basis, while enabling and encouraging health professionals to improve the overall quality and delivery of healthcare nationwide.
Blue Distinction Centers for Bariatric Surgery®
Blue Distinction Centers for Bariatric Surgery provide a full range of bariatric surgical care services including inpatient care, post-operative care, follow-up and patient education. These facilities must meet stringent quality criteria, as established by expert physician panels, surgeons, behaviorists and nutritionists.
Blue Distinction Centers for Cardiac Care®
Blue Distinction Centers for Cardiac Care provide a full range of cardiac care services, including inpatient cardiac care, cardiac rehabilitation, cardiac catheterization (including percutaneous coronary interventions) and cardiac surgery (including coronary artery bypass graft surgery)1. These facilities must meet stringent quality criteria, as established by expert physician panels and national organizations.
Blue Distinction Centers for Complex and Rare Cancers®
Blue Distinction Centers for Complex and Rare Cancers have received their designation based on surgical case volume for adults with certain complex and rare cancers, as well as structure and process criteria. There is evidence supporting that for many complex and rare cancers, higher surgical volume is related to improved patient outcomes. Our first phase of the program assesses facilities on evaluation, treatment planning, complex inpatient care and major surgical treatments; all delivered by multidisciplinary teams with distinguished expertise and subspecialty training for complex and rare cancers.
While this designation is meant as a comprehensive indicator of quality, facilities were required to submit data on each of the individual cancer types as part of the evaluation process. The cancers were split into two groups based on the strength of available evidence and, to a lesser extent, rarity of the cancer type. The cancer types with stronger evidence were weighed more heavily during the evaluation process.
To become a Blue Distinction Center for Complex and Rare Cancers, facilities had to satisfy criteria for at least five of the eight main cancers. The additional cancer types were also evaluated and are intended to be another resource for patients and providers. Each cancer type, regardless of group, had three criteria areas that had to be met for an applicant to satisfy qualifications:
- Multidisciplinary treatment team and corresponding sub-specialty training (varied by type)
- Regular meetings of sub-specialized, multidisciplinary tumor board/cancer conferences
- Minimum annual average surgical case volume
Main cancers used for this designation evaluation:
- Bladder cancer
- Brain cancer – primary
- Esophageal cancer
- Gastric cancer
- Liver cancer – primary
- Pancreatic cancer
- Rectal cancer
- Acute leukemia (inpatient, non-surgical)
Additional cancers:
- Bone cancer – primary
- Head and neck cancers
- Ocular melanoma
- Soft tissue sarcoma
- Thyroid cancer – medullary or anaplastic
The evidence-based selection criteria for this program were developed in strategic collaboration with the National Comprehensive Cancer Network (NCCN)*, and a panel of expert clinicians.
Blue Cross and Blue Shield recognizes that the majority of patients' multidisciplinary treatment may be best accomplished by integrating the expertise available in a Blue Distinction Center® with locally available treatment resources, especially for outpatient chemotherapy and radiotherapy, based on individual circumstances and patient preference. Optimal support of a patient's comprehensive cancer care needs may be achieved by coordination of care between the patient and their family, local physicians, the Blue Distinction Center and their local Blue Cross and Blue Shield company.
* This organization has provided information and input, but does not formally endorse the Blue Distinction Centers program.
Blue Distinction Centers for Knee and Hip Replacement is a new Blue Distinction designation that is awarded to medical facilities exhibiting a commitment to quality care, resulting in better overall outcomes for patients who undergo knee and hip replacement procedures. Blue Distinction Centers for Knee and Hip Replacement will have demonstrated experience in offering comprehensive inpatient knee and hip replacement services, including total knee replacement and total hip replacement. Candidates for this designation must submit clinical data to establish that they meet objective, evidence-based thresholds for clinical quality.
Blue Distinction Centers for Spine Surgery is also a new Blue Distinction designation that is awarded to medical facilities exhibiting a commitment to quality care, resulting in better overall outcomes for spine surgery patients. Blue Distinction Centers for Spine Surgery will have demonstrated experience in offering comprehensive inpatient spine surgery services, including discectomy, fusion and decompression procedures. Candidates for this designation must also submit clinical data to establish that they meet objective, evidence-based thresholds for clinical quality.
Blue Distinction Centers for Transplants®
The Blue Distinction Centers for Transplants program examines the following transplant types:
- heart
- lung (deceased and living donor)
- combination heart/lung
- liver (deceased and living donor)
- simultaneous pancreas kidney (SPK)
- pancreas (PAK/PTA)
- bone marrow/stem cell (autologous & allogeneic)
Additional value-added services provided within this transplant network include global pricing, financial savings analysis and global claims administration support, as well as support services such as referral management, patient satisfaction survey reports and transplant-related continuing education programs for Blue companies.
Click here for additional resources and facts about transplant services.
1 At the discretion of the local BCBS company and under a specified contingency process, a facility that provides the full range of cardiac services but does not provide on-site coronary artery bypass graft (CABG) surgery may be considered for designation if it is part of a cooperative system with a qualifying facility that provides emergency backup CABG for percutaneous coronary interventions (PCI) and meets the contingency criteria. Blue Distinction Centers for cardiac care without on-site CABG will be differentiated from full-service Blue Distinction Centers for cardiac care in program listings.
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. To find out which services are covered under your policy at these or any other facilities, please call your local Blue Cross and/or Blue Shield Plan; and please call your provider before making an appointment, to verify the most current information on their Network participation status. Neither Blue Cross and Blue Shield Association nor any of its Licensees are responsible for any damages, losses, or non-covered charges that may result from using this Web site or receiving care from a provider listed in this Web site.
