Health Plans Launch Bariatric COE Programs Based on the ASMBS BSCOE Program

Over 245 million health plan members are impacted by the ASMBS BSCOE program in some manner. Health plans across the country use the ASMBS BSCOE designation to determine which hospitals and surgeons are included in their provider directories. Quality measures, geographic access, state and federal law, customer demand and the payment agreement between the hospital or surgeon and the health plan are all factors considered when health plans select their panel of “in-network” bariatric surgery providers. A number of health plans are preparing to launch bariatric centers of excellence programs that base their facility and surgeon selection on the ASMBS BSCOE designation. They will join others like Humana, Medicare, Medica, Medical Mutual of Ohio and BlueCross Blue Shield of Massachusetts who already have such programs.

Harvard Pilgrim Health Care is a not-for-profit health plan that provides a variety of insurance plan options and self-funding arrangements to more than one million members in Massachusetts, New Hampshire and Maine. A Strategic Alliances Group member, Harvard Pilgrim selects their list of providers meeting specific quality criteria for weight loss surgery from providers that receive the ASMBS BSCOE designation or the ACS Level 1 designation. For more information about the COE program, go to Harvard Pilgrim Health Care – Find a Doctor.

“Harvard Pilgrim has received accolades for member satisfaction and quality of care from U.S. News & World Report. Creating a COE program that utilizes the ASMBS BSCOE program is another effort toward providing information on quality to our members,” says Maura Lapping, Director of medical Administration Medical Management & Quality.

WPS Health Insurance, a non-profit health plan representing 200,000 members, is also launching a pilot COE program based upon ASMBS BSCOE designees. “WPS has found the criteria — developed and used by SRC and the ASMBS to qualify bariatric surgeons and bariatric surgery centers for the Bariatric Surgery Center of Excellence® designation — to be very valuable in guiding our decision-making,” states Lois Sater, Vice President of Medical Affairs. “It is very necessary to improving quality in bariatric surgery — a surgery once considered high risk.”

Cigna Healthcare, a long-time member of SRC’s Strategic Alliances Group, is also developing a COE program utilizing the ASMBS BSCOE hospitals and surgeons.

“SRC values the trust health plans are placing in our organization,” says Jackie Lueck Sneve, Vice President of Strategic Alliances. “They could choose to create a COE program without us. However, their reliance on SRC speaks volumes.”

SRC's Strategic Alliances Division continues to work with payors across the nation toward the goal of making bariatric surgery a core benefit. Let us know about coverage issues your program may be experiencing.

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