Blue Cross of Calif. Steers Patients Toward Best Hospitals for CABG


California seems to be the place where health plans have decided to crack down on hospital costs by spurring better outcomes. Blue Cross of California, for example, says it is relying on evidence-based reports on volume and quality of outcomes for coronary artery bypass grafts (CABG) in launching its Centers of Expertise program.

The idea sounds simple and familiar to anyone in the managed care industry: Steer patients in need of certain procedures to those hospitals that do them best. Enacting this supposedly simple approach has always been the challenge.

Blue Cross officials say they believe that they are answering that challenge.

Blue Cross's effort follows on the heels of a program launched by Blue Shield of California to tier hospitals according to cost and generally recognized quality measures.

In Blue Cross's program, 70 hospitals out of the 120 in the health plan's network that perform CABG have been selected for the Centers of Expertise. Selection was based on requests for information from Blue Cross, data from the state's CABG Quality Reporting Program, and fact sheets published by the Leapfrog Group.

Business leaders are welcoming the effort. "There are huge variations in the quality and efficiency of care provided by hospitals and physicians," says Peter Lee, JD, chief executive officer of the Pacific Business Group on Health.

"By educating enrollees on quality indicators such as CABG scores and Leapfrog ratings, Blue Cross is taking seriously its responsibility to help consumers make the best health care decisions possible."

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