Blue Distinction Selection Criteria Overview

What Measures are Used in Evaluating Facilities for Blue Distinction?

The designation is based on rigorous, clinically meaningful measures (or "selection criteria") established in collaboration with leading doctors, medical societies and professional organizations. The goal is to help consumers find healthcare facilities that have demonstrated better overall outcomes (e.g., fewer medical complications, fewer readmissions and higher survival rates) in the delivery of specialty care.

For each specialty area, BCBS collaborates with leading professional organizations to do a thorough review of nationally established measures and includes input from expert panels and medical organizations.

For the existing Blue Distinction Centers, the list of collaborators includes:*

Blue Distinction Centers for Cardiac Care

American College of Cardiology (ACC)
Society of Thoracic Surgeons (STS)

Blue Distinction Centers for Bariatric Surgery

American Society for Metabolic Bariatric Surgery (ASMBS)
Surgical Review Corporation (SRC)

Blue Distinction Centers for Transplants

Center for International Blood and Marrow Transplant Research (CIBMTR)
Scientific Registry of Transplant Recipients (SRTR)
Foundation for the Accreditation of Cellular Therapy (FACT)

Blue Distinction Centers for Complex and Rare Cancers

National Comprehensive Cancer Care Network (NCCN)

Does Blue Distinction Consider Cost of Treatment as Well as Quality?

The goal of this program is to raise the overall quality of healthcare being delivered across this country so the national selection criteria for Blue Distinction focus on quality indicators, not costs.

Overview of Selection Criteria

The following table provides an overview with examples of the measures used to determine whether a facility meets the quality thresholds of Blue Distinction. View detailed selection criteria for each Blue Distinction specialty area: Bariatric Surgery, Cardiac Care, Complex and Rare Cancers, or Transplants:

Selection Criteria Category	Examples Include	Why This Matters to You
Patient Results (or Patient Outcomes)	Complication rates Readmission rates Mortality rate	Published averages for these measures often exist. Facilities are evaluated on how they compare to these averages to assess how well they do, overall, relative to their peers.
Treatment Expertise	Physician credentials Dedicated team focused on providing the particular area of specialty care Length of time a facility has performed a procedure	Processes like advanced training programs for physicians in certain specialty areas and having patient care teams dedicated to one type of specialty care may lead to better overall care and outcomes for patients.
Procedure Volume	Number of times a particular procedure has been completed	Experience counts. Like the old adage, “Practice makes perfect,” research has shown that the more a facility performs a particular procedure, the better the overall outcomes for patients. It is worth noting, however, that this does not guarantee positive outcomes for individual patients.
Structure	Type of services provided (ER, diagnostic testing abilities) Supporting departments (radiology, nutrition, social services, rehabilitation, etc.) Use of clinical registry data systems	Expert input and guidance suggest that for various specialty care services, a distinguished level of care and management of patients requires the availability of key clinical services, such as diagnostic, medical and collaborative services.
Process	Use of evidence-based care (e.g., use of beta blockers or aspirin for cardiac patients, which typically results in better outcomes) Systematic follow-up of patient results after procedures Quality improvement processes	Adherence to evidence-based (or clinically based) care processes, as well as a demonstrated focus on quality improvement, often relate to improved overall outcomes.

Do Designations Expire?

All facilities must reapply for the designation on a regular basis (typically every 18 - 36 months) to help maintain consistent quality among facilities that have earned the Blue Distinction designation. These re-evaluation cycles provide an opportunity for BCBS to work with clinical experts to determine if any of our quality thresholds should be raised based on then current clinical practice, fostering ongoing opportunities for improving the overall quality of care.

Where Can I Learn More?

To find a Blue Distinction Center near you, visit our Blue Distinction Center Finder. For questions regarding your benefit coverage, please contact your local Blue Cross and/or Blue Shield company.

View a PDF of the Blue Distinction Selection Criteria Overview.

* These organizations have provided information and input, but do not formally endorse the Blue Distinction Centers program.

Note: Designation as Blue Distinction Centers means 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 any facilities, please call your local Blue Cross and/or Blue Shield company; and call your provider before making an appointment, to verify the most current information on their network participation status.

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