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Determining Cost & Quality Designations

Earlier this year, Blue Cross and Blue Shield of North Carolina (BCBSNC) responded to our customers’ increasing demand for cost-efficient and high-quality health care by introducing Blue SelectSM, a tiered benefit product.  This new plan received strong market response, and in an effort to provide continued improvements to our offerings, BCBSNC is increasing transparency and accessibility to quality and cost information across health plans.

Our goal is for all BCBSNC members to be able to make more informed decisions when choosing health care providers.  In an effort to facilitate this, we’ve created new Cost & Quality Designations:

  • Hospitals that exceed both quality and cost thresholds will have the “Low Cost & High Quality” designation.
  • Hospitals that meet only the quality threshold will have the “High Quality” designation.
  • Critical-access hospitals will be noted as such.
  • All other hospitals will not have a designation.

Because of these differences, it is possible that a facility’s Cost & Quality Designation may differ from its Blue Select tier.  Please note that reimbursement rates will remain unchanged as a result of these Cost & Quality Designations, and for most BCBSNC members there will be no benefit differential based on the Cost & Quality Designations in 2014.  The designations were used in the value-based benefit plans being offered by the NC State Health Plan. 

Both the BCBSNC Cost & Quality Designations and the State Health Plan’s Designations will be available for members to see on our online provider search tool when they search for a particular facility: 

BCBSNC Cost & Quality Designation

State Health Plan Benefit Designation

Low Cost & High Quality

Designated for Cost & Quality

High Quality

Not Designated

Critical Access Hospital

Designated for Critical Access

No Designation

Not Designated

 General information related to the overall methodology used to determine provider designations can be found online under the “Quality-Based Programs” section of the provider portal.  If you have any questions about our Cost & Quality Designations, please contact your BCBSNC Strategic Provider Relationships consultant directly or via email at designation@bcbsnc.com.