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Blue Distinction Selection Criteria Overview

Blue Distinction® is a designation given by Blue Cross and Blue Shield (BCBS) companies to healthcare facilities (typically hospitals) that have demonstrated expertise in delivery quality healthcare. At the core of the Blue Distinction program are the Blue Distinction Centers for Specialty Care® ― facilities that are recognized for their distinguished care in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery or transplants.

What Measures are Used in Evaluating Facilities for Blue Distinction?

The designation is based on rigorous, clinically meaningful measures (or “selection criteria”) established with expert physicians’ and medical organizations’ recommendations. 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 does a thorough review of nationally established measures and gathers input from expert physicians and medical organizations. For the existing Blue Distinction Centers®, the list includes:*

Blue Distinction Centers for Bariatric Surgery®

  • American Society for Metabolic Bariatric Surgery (ASMBS)
  • Surgical Review Corporation (SRC)
  • American College of Surgeons (ACS)

Blue Distinction Centers for Cardiac Care®

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

Blue Distinction Centers for Complex and Rare Cancers®

  • National Comprehensive Cancer Care Network®(NCCN)

Blue Distinction Centers for Knee and Hip Replacement®

  • American Academy of Orthopaedic Surgeons (AAOS)
  • American Board of Orthopaedic Surgeons (ABOS)

Blue Distinction Center for Spine Surgery®

  • American Association of Neurological Surgeons (AANS)
  • North American Spine Society (NASS)

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)

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 the country so the national selection criteria for Blue Distinction focus on quality indicators.

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.

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.

View detailed selection criteria for each Blue Distinction.

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 expert physicians and medical organizations to determine if any of the 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 Plan; and call your provider before making an appointment, to verify the most current information on its Network participation and Blue Distinction 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 website or receiving care from a provider listed in this website.