Blue Cross has new tiered plan to rank hospitals

MINNEAPOLIS - Blue Cross and Blue Shield of Minnesota has a new plan that places Minnesota hospitals in two categories, and offers some relief to patients who use the facilities that are deemed less expensive.



Employers could save between 5 and 10 percent of their health care costs if they persuade employees to use hospitals and doctors that Blue Cross designates as "Tier I" care providers. Using the more expensive "Tier II" facilities will cost patients more - their co-payments or coinsurance could be two to three times as high.



The hospital rankings will be released in about two weeks, Blue Cross spokeswoman Jan Hennings said Monday.



The providers and doctors that fall into the Tier II category face a loss in valuable patient traffic from the dominant insurer in the state.



"We want employers to encourage employees to take more interest in the health care choices they make," said Jan Lysen, vice president for network management for Blue Cross and Blue Shield.



Lysen said Tier I providers must meet minimum quality standards and agree to take specific steps to improve quality in various care areas.



Blue Cross, the state's largest health insurer, is evaluating hospitals on seven patient care criteria, including whether they formally track their postoperative infection rates and use a computerized system to order drugs. Other factors include nurse-patient ratio and the presence of a pain management program.



The insurer is also evaluating providers on their costs. The highest-quality providers can still be in the lower tier if the insurers decide they are too expensive.



Information about Blue Cross' two-tier provider structure first appeared as an announcement to state physicians on the Web site of the Minnesota Medical Association.



The association told doctors the system "is likely to spark controversy" and said it is discussing concerns, which it did not specify, with Blue Cross.



The association declined to comment further on Monday.



The two-tiered coverage will be offered to businesses with 51 or more employees starting next year.



HealthPartners has been ranking providers for more than 10 years, and 18 months ago it upgraded the quality and cost elements of its ranking system.



Senior Vice President Scott Aebischer said the HealthPartners plan gives providers incentive to improve on more than 70 factors on which they are judged.



"We've been very transparent about our quality information with our providers," he said. "They know where we stand."