Resources

Since the inception of this program, Blue Cross has continued to provide more meaningful information to consumers in an effort to foster informed decision making relative to their healthcare, while streamlining processes for the provider. Hospitals will continue to be evaluated in three categories. While the categories may look similar to past years, there may be changes to the measures within the categories. The three evaluation categories are:

• Cost
  Focuses on performance against financial benchmarks across inpatient and outpatient services 
• Quality
  Focuses on performance on Centers for Medicare and Medicaid Services (CMS) hospital process measures and risk adjustment readmission rate
• Patient Experience
  Focuses on performance on the CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey relative to patient experience in member hospitals

Based on the scores received in these three categories, hospitals are ranked as Lower or Higher Cost Share facilities. This ranking replaced our previous tiering system. Being a Low Cost Share hospital provides more benefits to our members.

For additional information, see the resources below or contact your Provider Networks Consultant at 1-866-904-4130.