Nov. 18 (Bloomberg) -- Heart patients have lower costs when treated at hospitals that are top-rated for quality, according to a review of claims by Blue Cross plans.

The patients also had lower readmission and infection rates in facilities that scored highest on objective standards for heart bypasses and artery-unclogging procedures, according to the study to be released today. The review of 41,000 heart patients was conducted by the Blue Cross and Blue Shield Association, a health-plan federation with 102 million members made up of WellPoint Inc. and nonprofit organizations.

The analysis foreshadows greater use of health data to match patients with the best providers for their needs, said Joe Singer, a vice president at WellPoint's HealthCore subsidiary, which did the research. Other insurers, such as Cigna Corp., have set up a tier of their best network providers.

``There's a myth that top quality means the most expensive,'' Singer said in a telephone interview yesterday. ``For some of these very technical and frequently performed procedures, the designated centers had equal if not better results.''

The Blue Cross association has labeled more than 800 hospitals in 45 states as Blue Distinction centers for heart care, obesity surgery, transplantation, or treatment of complex or rare cancers. Spine-surgery and joint-replacement centers will be named later, the group said.

It's up to individual health plans and thousands of employers to decide how to use the ratings, said Carol Redding Flamm, the Blue Cross association doctor managing the Blue Distinction evaluation program. Some Blue Cross plans have begun rewarding Blue Distinction patients with lower out-of-pocket costs, while others are exploring ``benefit differentials,'' she said.

WellPoint Copayments

Some plans from Indianapolis-based WellPoint offer lower copayments for transplants and obesity care in Blue Distinction centers, said company spokeswoman Lori McLaughlin in an e-mail.

Blue Distinction heart centers met minimum scores in surveys of services, death rates, staff, how often procedures were performed and the use of certain drugs upon admission and discharge, the group said. More than 50 criteria in the survey were set in collaboration with specialty medical societies. The information is made public to minimize resistance from doctors and hospitals, said Flamm.

Among the designated cardiac centers are Yale New Haven Hospital in Connecticut, Newark Beth Israel Medical Center in New Jersey, the University of Maryland Medical Center in Baltimore, St. Luke's Episcopal Hospital in Houston, and Silver Cross Hospital in Joliet, Illinois.

Health plans won't get much mileage from these programs if they don't distill the information for consumers, said Thomas P. Miller, a health policy fellow at the American Enterprise Institute, a Republican-oriented Washington think tank.

Simplfying for Consumers

``You have to oversimplify this to get an effective response from the consumer side, and you can't provide the granular detail desired by the medical community,'' Miller said. Another challenge is managing the inevitable ``knee-jerk blowback'' from providers who don't want to be seen as second-rate, he said.

The HealthCore survey found that patients who had heart- bypass surgery at Blue Distinction centers in 2006 were readmitted 13.2 percent of the time compared with 16.7 percent at other facilities. Health plans spent an average of $45,215 on each episode, 4.8 percent less than the average cost at hospitals lacking the designation, Flamm said.

For angioplasties, procedures that use an inflatable tube threaded through the arteries to unclog blood vessels in the heart, the average cost was $18,993, about 12 percent less than the same procedures done at hospitals that didn't meet standards. The readmission rate at designated hospitals was 10.6 percent, compared with 15.5 percent at other facilities, Flamm said.

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To contact the reporter on this story: Avram Goldstein in Washington at agoldstein1@bloomberg.net.

Last Updated: November 18, 2008 00:01 EST