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Provider Network
Blue Shield's provider network offers your clients the choice and coverage they need:
 
  • Access to thousands of doctors, hospitals and dental and vision care providers.
  • National and international access to health care through the BlueCard® program.
Broad California Networks
Blue Shield has some of the most expansive and diverse provider networks in California, offering easy access to hospitals, physicians, and a variety of specialty and ancillary providers.
 
Blue Shield of California networks are some of the largest in California. *The HMO network has more than 34,000 physicians and 290 hospitals and the PPO network includes more than 60,000 physicians and 351 hospitals. We also offer members cost-effective care options at hundreds of skilled nursing facilities, ambulatory surgery centers, dialysis centers, and urgent care centers.
 
Our extensive network coverage gives our members access to choose from one of largest provider networks wherever they live or work.  Our assemblage of providers in California helps ensure our new members will be successful in their ability to keep their same physicians.
Additional Providers Beyond California
Provider access for Blue Shield members doesn't end at the California state border.
 
Nationally our affiliation with the BlueCross BlueShield Association’s BlueCard® Program allows us to offer one of the largest networks coast to coast.  The BlueCard® Program allows Blue Shield of California members to obtain healthcare services while traveling or living in another Blue plan service area.
 
Members can find participating BlueCard providers (including general practices, retail clinics, urgent care centers, and hospitals) using our website’s Find a Provider feature.
International resources for our members:
  • The BlueCard Worldwide Program enables your clients' employees and affiliated subscribers to benefit from the BlueCross BlueShield Association's relationships with more than 400,000 providers around the world.
     
  • We've developed Access Baja HMO, a California-based, cross-border health plan for employees and their dependents to receive care in Mexico.
Find a Provider Web Tool
Our online provider directory’s advanced search capabilities can find qualified providers conveniently located close to home within California as well as providers across the country and around the world. Our website gives members access to a listing of doctors, medical groups, dentists, vision care providers, specialists, hospitals, pharmacies, and urgent care centers. 
 
In addition, the online directory supports our members in their healthcare decision-making by designating providers that have met certain quality and performance criteria used by the programs described below. Go to blueshieldca.com and access Find a Provider now.
Network Management Innovations and Leading Edge Programs
Blue Shield of California participates in programs that are dedicated to improving the quality and lowering the cost of health care. We work hard with providers and use provider performance data to identify opportunities to improve quality, lower costs, and help our members make wise healthcare choices.
Accountable Care Organizations
Given the success of our CalPERS pilot in Sacramento, we are committed to developing additional Accountable Care Organizations across the state.  These arrangements between selected hospitals, physician groups and Blue Shield are designed to increase efficiencies, reduce costs and improve quality through greater integration and data sharing.  Our partnership with Hill Physicians and Catholic Healthcare West on behalf of 41,000 CalPERS members in Sacramento produced significant results, including a 17% reduction in readmission rates, a 14% reduction in bed days, and a half day reduction in average length of stay. We hope to implement more accountable care organizations in other regions.
Partnership in Operational Excellence and Transparency (POET)
POET promotes information sharing and process improvement to address one of the main priorities of providers: fast, accurate claims payment.  The purpose of the POET program is to improve the customer experience by better managing our end-to-end business processes.
 
Since launching in 2008, POET has reduced administrative costs for delivering health care and increased satisfaction for network providers and Blue Shield. Participating hospitals and medical groups have welcomed the resulting reductions in claim denial volume, faster claim processing and payments, quicker resolution of claim disputes and fewer “re-works” for submitted claims. POET’s success has resulted in stronger relationships with providers, administrative efficiency, and reduced costs for healthcare providers and Blue Shield. Currently, 120 hospitals and more than 30 physician groups from our network throughout California participate in the program. Participating hospitals and medical groups are pleased with resulting reductions in claims denials and rework volume, and 90% of hospitals rated POET to be better than the similar programs competitors offer.
 
Claims denial rate has improved by almost 30% over the last 3 years (from 22.8% in 2008 to 16.1% in 2011).
 
In addition to these proprietary initiatives, Blue Shield participates in a variety of industry programs for hospitals and physicians summarized below.
Blue Distinction Centers Program
This program awards a national quality designation to hospitals and medical facilities that have demonstrated expertise in delivering quality health care in inpatient and outpatient arenas. 
 
We’re proud that many of the facilities within our networks are recognized nationally as meeting these high standards. Each hospital recognized as a Blue Distinction Center® is designated in our online provider directory, Find a Provider.
California Hospital Assessment Reporting Taskforce (CHART)
This statewide hospital report card is developed and maintained by key California healthcare organizations across both the public and private sectors.  Consumers can check and compare hospital results by going to the CHART consumer website: http://www.calhospitalcompare.org/
 
CHART data is one of the metric sets that we use to compare the quality of our network hospitals for the CalPERS Narrow Network and other hospital initiatives.
 
Hospitals recognized as participating in CHART are designated in our online provider directory, Find a Provider.
Pay for Performance (P4P) Program
In 2003, we began participating in an initiative sponsored by Integrated Healthcare Association (IHA) to implement a uniform incentive program for California physician organizations. 
 
P4P measures the performance of 150 Blue Shield provider groups and rewards high performers with financial incentives.  The performance measures include prevention and chronic care, patient experience, technology adoption to support patient care, and efficiency measures.
 
Medical groups participating in our P4P program can also be found on our online provider directory, Find a Provider.
 
You can find the physician organization clinical care report card at: http://iha.ncqa.org/reportcard/ 
 
You can find the physician organization patient experience report card at:
http://opa.ca.gov/report_card/medicalgroupcounty.aspx
Blue Shield's Blue Ribbon Recognition Program and the California Physician Performance Initiative (CPPI)
On June 1 2010, Blue Shield launched a program to recognize our “blue ribbon” physicians. The program identifies high-volume physicians who have met certain program benchmarks, and seeks to stimulate even greater quality improvement at the physician level. Blue Shield is the first and only health plan in California to integrate quality metrics at the point of individual Physician Selection by recognizing 6,000 high-volume, higher-performing physicians with a blue ribbon on our online provider directory, Find a Provider. These Blue Ribbon physicians perform well in eight measures of care.
 
The Blue Ribbon Recognition Program is based on individual physician quality scores from the California Physician Performance Initiative (CPPI), managed by the Pacific Business Group on Health. The CPPI claims-based measures are used widely throughout the industry to measure and publicly report health plan and medical group quality.

* The network counts for HMO/PPO contained on this website are for Blue Shield of California.  Blue Shield of California Life & Health Insurance Company offers health insurance and has a large, but separate, provider network.  It is important to make sure your client's provider accepts their health coverage before accessing covered benefits.
 
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