Highmark launches group plan

On April 1, Highmark Inc. unveiled a group health plan aimed at larger employers and self-insured businesses that provides incentives for members to use providers that exhibit higher quality outcomes, fewer complications and reduced readmissions.

Called Blue Distinction Benefits, the group offering encourages members to use Blue Distinction Centers, a listing compiled by the BlueCross BlueShield Association of providers across the country who meet quality criteria in six separate high-cost, high-risk areas of specialty care.

“The best way to think about the program is that the Blue Distinction Centers have identified (the providers that) have kept the best lid on complications and readmissions, which are implicit in increasing costs,” said Eric Hays, vice president of western regional markets for Highmark.

The reason for adding the new group product to its current line up of offerings is to provide employers with another product that helps lower the overall costs of health coverage. The savings should come from a more active management of employee health by providing employers with close to real-time health data, while also encouraging the employees to use the Blue Distinction Centers via incentives in the plan. 

The Blue Distinction designation focuses on patient safety and outcomes in six specialty areas: bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery and transplants. According to the BlueCross BlueShield Association, treatments of these conditions account for roughly 30 percent of all hospital inpatient costs.

The Blue Distinction Centers program began in 2006 primarily as a tool to help Blue plan members identify quality providers as well as for doctors to consult when making a referral for any of the six specialty areas explained Jody Voss, vice president of business strategy at the BlueCross BlueShield Association.

But as the years have gone by and the attention in the market has turned to quality, Voss said that there has been more interest in the program from its member companies.

“We do see that there is more discussion by local Blue plans to develop these products in a way that is similar to Highmark,” Voss said. And while the BCBS Association regularly ups the ante when it comes to qualifying for the program, it has always focused solely on care quality, not price  – until now.

Earlier this year, the association launched Blue Distinction Center +, which is now rolling out the cost savings exhibited by the hospitals in the program. To date, the new program has cost information posted for both hip and knee replacement surgeries and spinal surgery and will roll out the other four specialties in the coming months.

According to Joe Fortuna, chair of the American Society for Quality’s healthcare division, the move by Highmark is a step in the right direction of health insurers looking to encourage its members to seek out high-quality providers.

“I think if they want to, insurers can be extremely effective in helping to improve quality in the system,” Fortuna said. “It’s all about incentives. If they can work collaboratively with physicians and the providers they can help evolve good quality performance measures that have meaning.”

Under the new plan provided by Highmark, a few different cost-sharing designs are offered to encourage the use of the Blue Distinction Centers. The cost-sharing options are:

   Decreased member cost sharing, such as waived deductibles and/or coinsurance/copays, for members who utilize a Blue Distinction Center to receive specialty care;

    Additional copays for members who utilize a non-Blue Distinction Center to receive specialty care; or

    No coverage for members who do not utilize a Blue Distinction Center to receive specialty care.

Members of these plans can use Highmark’s online provider search tool to locate the nearest Blue Distinction Center near them.