Bariatric Surgery Selection Criteria

1 Program Selection Criteria : Bariatric Surgery Released June 2017. Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria 2013 Benefit Design Capabilities Survey . About This 1. About the Blue Distinction About This Document Specialty Care Program .. 1. The Program Selection Criteria outlines the Selection Criteria and evaluation process used Executive Summary .. 1 to determine eligibility for the Blue Distinction Centers for Bariatric Surgery program (this Program). Understanding the Evaluation Process .. 2 This document is organized into five sections: 1. Overview of the Blue Distinction Specialty Care Program quality Selection Criteria .. 4. 2. Evaluation process and data sources Business Selection Criteria 9. 3. quality Selection Criteria Cost of Care Selection Criteria 4.

2 Business Selection Criteria .. 10. 5. Cost of Care Selection Criteria 13. About the Blue Distinction Specialty Care Program Blue Distinction Specialty Care is a national designation program recognizing healthcare providers that demonstrate expertise in delivering quality specialty care safely, effectively, and cost efficiently. The goal of the program is to help consumers find both quality and value for their specialty care needs, while encouraging healthcare professionals to improve the overall quality and delivery of healthcare nationwide, and providing a credible foundation for local Blue Cross and/or Blue Shield Plans (Blue Plans) to design 1. benefits tailored to meet employers' quality and cost objectives . The Blue Distinction Specialty Care Program includes two levels of designation: Blue Distinction Centers (BDC): Healthcare providers recognized for their expertise in delivering specialty care.

3 Blue Distinction Centers+ (BDC+): Healthcare providers recognized for their expertise and cost-efficiency in delivering specialty care. quality is key: only those providers that first meet nationally established, objective quality measures for BDC will be considered for designation as a BDC+. Executive Summary In late 2016, local Blue Plans invited 1,775 facilities across the country (consisting of comprehensive acute care inpatient facilities and ambulatory Surgery centers) to be considered for the Bariatric Surgery designation under this Program; over 750 facilities applied and were evaluated on objective, transparent Selection Criteria with quality , business, and cost of care components. 1. Benefit design is determined independently by the local Blue Plan and is not a feature of any Blue Distinction program. Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies.

4 1. Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria p2013 Benefit Design Plan Capabilities Survey About This Document .. 1. The Program uses updated metabolic and Bariatric Surgery accreditation and quality improvement Program (MBSAQIP) accreditation levels, which focus on site of service. About the Blue Distinction Specialty Care Program .. 1. With this design change, each facility can apply to achieve the BDC or BDC+ designation, as either a Comprehensive Center (including outpatient capability) or an Ambulatory Executive Summary .. 1 Surgery Center (ASC). Understanding the Evaluation Process .. 2 PROGRAM HIGHLIGHTS. quality Selection Criteria .. 4 Designation Levels BDC. BDC+. Business Selection Criteria 9. Accreditations National accreditation organizations Considered Bariatric -specific program accreditations Cost of Care Selection Criteria .

5 10 Comprehensive, Acute Care, Inpatient Facility Facility types considered for this Program Ambulatory Surgery Center 13. Evaluated Procedures Laparoscopic Sleeve Gastrectomy Laparoscopic Roux-en-Y Gastric Bypass Laparoscopic Adjustable Gastric Band Data Sources quality : Provider Survey Business: Plan Survey, Blue Brands evaluation, and Local Blue Plan Criteria (if applicable). Cost: Blue Plans' healthcare claims data quality Data Cases occurring between Jan. 1, 2015 and Dec. 31, 2015. October 2016 metabolic and Bariatric Surgery accreditation and quality improvement Program (MBSAQIP) Semiannual Report (SAR). Cost Data Blue Plans' Preferred Provider Organization (PPO) healthcare claims data, with cases occurring between Jan. 1, 2013 and Dec. 31, 2015. Blue Patients ages 18 - 64. Note: The complete Selection Criteria and evaluation process are described fully throughout the remainder of this document.

6 Understanding the Evaluation Process Selection Process The Selection process balances quality , cost, and access considerations to offer consumers meaningful differentiation in quality and value for specialty care facilities that are designated as BDC and BDC+. Guiding principles for the Selection process include: quality Nationally consistent approach to evaluating quality and safety was used, incorporating quality measures with meaningful impact, including delivery system features and specific quality outcomes to which all can aspire. Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. 2. Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria p2013 Benefit Design Plan Capabilities Survey About This Document ..1. Cost About the Blue Distinction Nationally consistent and objective approach for selecting BDC+ was used to Specialty Care Program.

7 1 address market and consumer demand for cost savings and affordable healthcare. Executive Access Understanding the Evaluation Blue members' access to Blue Distinction Centers was considered to achieve the Process ..2 program's overall goal of providing differentiated performance on quality and, for the BDC+ designation, cost of care. quality Selection Criteria ..4. Evaluation Components: Data Sources Business Selection Criteria .9. Objective data from detailed Provider Survey, Plan Survey and Blue Plan healthcare Cost of Care Selection Criteria claims data information were used to evaluate and identify facilities that meet the ..10 Program's Selection Criteria . A facility must meet the Program's specific Selection Criteria , defined by the following evaluation components (Table 1), to be eligible for the BDC or Questions ..13. BDC+ designation: Table 1: Evaluation Components BLUE BLUE.

8 EVALUATION DISTINCTIO DISTINCTION. DATA SOURCE. COMPONENT N CENTERS CENTERS+. (BDC) (BDC+). quality Information obtained from a facility in the Provider Survey.. Information obtained from the Business local Blue Plan in the Plan Survey and Blue Brands evaluation.. Cost of Care Blue Plan healthcare claims data.. Measurement Framework Blue Distinction Specialty Care programs establish a nationally consistent approach to evaluating quality and safety by incorporating quality measures with meaningful impact. Selection Criteria continues to evolve through each future evaluation cycle, consistent with medical advances and measurement in this specialty area. The measurement framework for this and other Blue Distinction value-based initiatives were developed using the following guiding principles: Utilize a credible process and produce credible results with meaningful, differentiated outcomes.

9 Align with other national efforts using established measures, where appropriate and feasible. Simplify and streamline measures and reporting processes. Enhance transparency and ease of explaining program methods. Blue Cross Blue Shield Association is an association of independent Blue Cross and Blue Shield companies. 3. Blue Distinction Centers for Bariatric Surgery | Program Selection Criteria p2013 Benefit Design Plan Capabilities Survey About This Document .. 1. Utilize existing resources effectively, to minimize costs and redundancies. About the Blue Distinction Meet existing and future demands from Blue Plans, national accounts, and Blue Specialty Care 1 Members. Executive Summary .. 1. quality Selection Criteria Understanding the Evaluation Process .. 2. This Program evaluates facility performance on one or more of the following procedures: Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass and/or quality Selection Criteria .

10 4 Laparoscopic Adjustable Gastric Band as either a Comprehensive Center (including outpatient capability) or an Ambulatory Surgery Center (ASC). Both Comprehensive Business Selection Criteria . 9 Centers and ASCs were evaluated on quality metrics developed through a process that included: input from the medical community and quality measurement experts; review of Cost of Care Selection Criteria medical literature, together with national quality and safety initiatives; and a thorough .. 10. analysis of meaningful quality measures. The quality evaluation was based on facility Questions .. 13 responses to the Provider Survey which included objective, quality metrics obtained from the facility's metabolic and Bariatric Surgery accreditation and quality improvement Program (MBSAQIP) Semiannual Report (SAR) from the October 2016 release (for procedures performed from 1/1/2015 to 12/31/2015).