March 2020
Blue Distinction® Centers for Cellular Immunotherapy Recognizes CAR-T Therapy
Blue Distinction® (BDC) is a national designation awarded by Blue Cross and Blue Shield (BCBS) Plans to recognize providers who demonstrate expertise in delivering quality specialty care − safely, effectively and cost efficiently. The goal of the program is to help patients find both quality and value for their specialty care needs, while providing a credible foundation on which employers may customize their employees’ benefits.
Distinction in Local Communities and Nationwide
The Blue Distinction Centers for Cellular Immunotherapy program aims to help support improved patient outcomes and affordability for members, beginning with individuals undergoing chimeric antigen receptor T cell (CAR-T) therapies. These are genetically-modified autologous T cell immunotherapies that may help bring new treatment options for certain cancer patients.
The treatment involves the genetic re-engineering of a patient’s white blood cells. Two CAR-T therapies have been approved recently by the U.S. Food and Drug Administration (FDA) to treat certain patients with leukemia (KymriahTM) and lymphoma (YescartaTM and Kymriah). The complexity and expertise needed to deliver these treatments supports identifying centers of excellence, through the Blue Distinction Centers for Cellular Immunotherapy program.
Providers that have been identified by a product manufacturer certification program to deliver CAR-T therapy will be invited to participate in this Blue Distinction program’s designation process. The program will continue to expand in the future as new treatments become FDA-approved.
Since these new CAR-T therapies have been recently introduced into clinical use, current insight into the episode of care and optimal clinical pathways is limited. As the Blue Distinction program and its selection criteria evolve, BCBS Plans will continue to work with the medical community to help identify meaningful clinical measures of quality and establish outcomes data that may help guide quality improvement for patient care.
Designation as a Blue Distinction Center for Cellular Immunotherapy differentiates providers locally, as well as nationally. This highly respected designation acknowledges the expertise providers have demonstrated and their commitment to improving quality and affordability. Designations are awarded based on quality criteria that support delivery of timely, coordinated, multidisciplinary, evidence-based care with a focus on quality improvement and patient-centered care.
In addition to meeting quality and business criteria, each designated facility is required to have a payment model for CAR-T specialty pharmacy products with their local Blue Plan that meets the value criteria, including protection against mark-up over the wholesale acquisition cost (WAC). Although a BDC+ designation is not offered at this time, the initial BDC designation incorporates an expectation of cost value. A Blue Distinction® Center+ (BDC+) level may be added in a future designation enhancement, once episode-based cost of care may be measured and risk adjusted meaningfully.
As the program evolves for a re-designation cycle, targeted for 2021, a global episode-based payment model including medical care services is anticipated to be added as an additional requirement.
The new Blue Distinction Centers for Cellular Immunotherapy program designations will be awarded on an ongoing basis, and the program will continue to expand as new providers become certified and eligible for designation.
For more information, visit the Blue Distinction® Specialty Care page.
Note: Designation as Blue Distinction Centers means these facilities’ overall experience and aggregate data met objective criteria established in collaboration with expert clinicians’ and leading professional organizations’ recommendations. The designation is not a guarantee of any particular outcome. Individual outcomes may vary.
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The information in this article is being provided for educational purposes only and is not the provision of medical care or advice. Physicians and other health care providers are to their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.