Status can affect policyholders’ costs

Andalusia Regional Hospital maintained its Tier 1 rating status, and Mizell Memorial Hospital was among those hospitals Blue Cross Blue Shield this week rated Tier 2.

Blue Cross Blue Shield of Alabama created the tiered program of hospitals in 2006 to ensure cost containment, quality and patient satisfaction at the hospitals in its network. This year’s criteria placed more emphasis on costs.

Blue Cross Blue Shield of Alabama members who use Tier 2 hospitals may pay a higher deductible, copay or coinsurance. Any difference in prices paid may be dependent on the type of policy held as well as the hospital’s ranking.

Mizell CEO Jana Wyatt said the Opp hospital missed a Tier 1 status by one-tenth of a point.

“The criteria used for the Tier system are cost, quality, and patient experience and Mizell focuses on each of these every day,” Wyatt said. “Many of the measures evaluated for Mizell are either at or above the national average. As you might imagine, hospitals across Alabama vary greatly from the level of service they provide to the population that they treat. Because of this, advantages and disadvantages are going to naturally exist in a standardized scoring system. For example, Mizell scored well on one quality measure that was not included in our calculation because our total number of BCBS admissions to the hospital for the reporting period was less than 100. The inclusion of this one measure alone would have kept us at Tier 1.”

Mizell will continue to be a Blue Cross Blue Shield provider, Wyatt said, adding that scores are reevaluated quarterly and the hospital could return to Tier 1 status in three months.

“There are efforts across the state to work with BCBS on the scoring disparities that exist, but changes are unlikely in the immediate future,” Wyatt said. “This just means that Mizell will work harder than ever to overcome the scoring disparity and continue to focus on all the things that matter including the measures that impact our Tier rating. “

Only select plans are subject to the Tiering System so many Blue Cross patients will have no impact whatsoever by Mizell’s change from a Tier 1 to a Tier 2 status, Wyatt said.

“ We have been able to identify some of the employer plans in the community subject to the Tiering System and have proactively communicated with these employers what this means to those covered by their plans,” she said. “Individuals can look at their individual policy information or call Blue Cross to determine if their plan is impacted. You are also welcome to call us for any questions about the BCBS Tiered Network at 334-493-9112.”

Andalusia Regional Hospital CEO John Yanes said BCBS’s Tier Network provides meaningful information to consumers based on cost, quality and patient experience.

“It’s a valuable tool to patients and employers in making healthcare decisions,” Yanes said. “There’s no doubt that patients and employers are having the carry a larger financial burden. Andalusia Regional Hospital achieving a Tier 1 designation further demonstrates ARH’s efforts to efficiently manage our operations and work with our physicians to achieve positive results.

“ARH was recently recognized as a Top Performer on Key Quality Measures by The Joint Commission and we were also designated as a Blue Cross Blue Shield Blue Distinction Centers for Maternity Care,” he said. “ The Tier 1 is a key performance indicator by the largest medical plan in Alabama and this designation further demonstrates ARH’s commitment to quality and service to our community.”

In the ratings announced this week and becoming effective April 1, 73 percent of Blue Cross’ network hospitals classified as Tier 1 and 27 percent classified as Tier 2.

“Due to recent increases in healthcare cost, this year’s criteria placed greater emphasis on cost,” according to a statement released by Blue Cross. “It is important that we continue to provide our members information about the more cost-effective hospitals.  Blue Cross members who use Tier 1 hospitals will have lower out-of-pocket costs for inpatient and outpatient care.”

Crenshaw Community Hospital in Luverne also moved from a Tier 1 to a Tier 2 rating, as did Evergreen Medical Center. Georgiana Medical Center maintained its Tier 1 rating.

A number of the state’s larger health facilities – including University of Alabama Hospital in Birmingham, Baptist Medical Center South in Montgomery, and Mobile Infirmary – were rated Tier 2.