Independence is pleased to announce that a new network solution, Flexible Network, will join the Blue Distinction® High-Performance Network Portfolio beginning January 1, 2019. Flexible Network, developed in partnership with the Blue Cross and Blue Shield Association (BCBSA) and Blue Cross® and Blue Shield® (BCBS) Plans across the country, has been designed to meet the growing demand from self-funded health benefit plans for innovative network solutions. The Flexible Network will help guide members to top-performing providers who participate in the BlueCard® PPO network through the introduction of customized benefit differentials.
What is the Blue Distinction® Portfolio of High-Performance Network Solutions?
Blue Distinction is a portfolio of high-performance network solutions that currently includes: Blue Distinction Total Care and Blue Distinction Specialty Care. Flexible Network will be added to the portfolio beginning in 2019.
For additional information about the Blue Distinction® Portfolio of High-Performance Network Solutions, visit the BSBSA’s website.
Developing the Flexible Network
Flexible Network is not a new network, but it adds flexibility to existing broad access PPO network(s) by allowing self-funded health plans to customize benefit differentials based on provider quality and cost information from BCBS Axis® data. Publicly available quality data from Hospital Compare and BCBS Healthcare Claims Data information were used to evaluate providers. Cost evaluation was based on a nationally consistent analysis of BCBS Plan claims data. Episodes of care were identified and defined using diagnosis and/or procedure codes billed by hospitals, ambulatory surgical centers (ASC), and physicians. A basket comprised of 191 episode types was used to evaluate acute care hospitals and ASCs.
Flexible Network includes all BlueCard PPO providers (i.e., all existing network providers remain in-network, while a subset of providers in selected markets are evaluated based on objective quality and cost criteria in order to compare them).
Independence intends to launch Flexible Network in 2019 with a subset of provider types: acute care hospitals and ASCs. Independence will not include primary care physicians in the Flexible Network in 2019. Additional provider types are planned for evaluation in 2020 and beyond.
Key features of the Flexible Network
Key features of the new Flexible Network include:
- Flexibility. The Flexible Network enables self-funded health plans to customize benefit differentials in order to balance quality, cost, and access based on employee needs and employer business objectives.
- Meaningful benefit differentials. The introduction of benefit differentials within the BlueCard PPO network is part of a larger industry movement to increase consumer engagement and help members make informed and appropriate choices for their medical care. Since access remains open within the BlueCard PPO network, members still have the ability to seek care from any provider, and there will be no change to how providers obtain a member’s benefits and eligibility.
- Member engagement and transparency tools. To support members in understanding how their choice in different providers results in different out-of-pocket costs, the benefit design will be communicated through transparency tools, cost estimators, and call centers.
What does this mean for providers?
Independence will communicate assigned groupings and additional details to affected hospitals and ASCs in the coming weeks.
What does this mean for Independence members?
Information about the Flexible Network will be communicated to Independence members enrolled in a Flexible Network product to help them understand how their choice of providers affects their out-of-pocket costs. Since access remains open within the BlueCard PPO network, members still have the ability to seek care from any participating provider.
For more information
We will publish additional information in future Partners in Health UpdateSM articles to help you when members present to your provider office for care. If you have any questions about the Flexible Network, please send an email to firstname.lastname@example.org.
The Blue Cross and Blue Shield Association is an association of independent Blue Cross and Blue Shield plans.