What the Blues are Doing
Designing incentive programs to ensure safety
Highmark Blue Cross Blue Shield’s QualityBLUE hospital pay-for-performance program aligns reimbursement with high-quality care and improved outcomes for patients. Through a partnership with 81 hospitals and about two-thirds of the primary care physicians in Highmark’s network, QualityBLUE addresses key healthcare quality issues such as reducing healthcare-associated infections. Based on both clinical and performance measures, Highmark conservatively estimates that reductions in healthcare-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) and central-line infections for the most recent four years, and the reduction of surgical site infections, deep vein thrombosis and pulmonary embolism in 2011, resulted in at least $48 million in savings. Hospitals participating in QualityBLUE prevented 2,796 adverse events, saving at least 384 lives through initiatives to improve healthcare quality and patient safety.
Anthem Blue Cross and Blue Shield’s initiative, Quality-In-Sights®: Hospital Incentive Program (Q-HIP®), financially rewards hospitals for practicing evidence-based medicine and implementing industry-recognized practices in the areas of patient safety, health outcomes and member satisfaction. The program drives improvements in health outcomes for patients in approximately 530 hospitals across the 14 states involved. For example, angioplasty complications decreased by 47 percent among participating hospitals. In addition, a new component of Q-HIP will require that hospitals renewing their contracts with Anthem Blue Cross and Blue Shield report quality benchmarks to qualify for a rate increase. This change is anticipated to reduce growth in the amount spent on inpatient care by three to five percentage points annually.
Horizon Blue Cross and Blue Shield of New Jersey, Inc. incorporates healthcare associated infection (HAI)-related measures into its Horizon Hospital Recognition Program. Horizon also covered a large portion of the costs for hospitals to acquire technology that empowers healthcare providers with actionable data and tools to educate staff and change procedures, resulting in fewer HAIs and saved lives. From 2005-2010, more than 10,000 HAIs have been avoided at the 23 participating hospitals, representing an estimated overall healthcare savings of nearly $36 million.
Preventing harm to patients
Blue Cross Blue Shield of Michigan is a key partner and funding source for the Michigan Health & Hospital Association’s Keystone: ICU Program, which has dramatically reduced central line-associated bloodstream infection (CLABSI) rates and ventilator-assisted pneumonia rates in ICU patients. The program is now used as a model for national CLABSI initiatives. More than 70 Michigan hospitals participate in this program, representing the most successful regional partnership of ICUs assembled for a single patient safety initiative. In six years, the initiative saved more than $300 million and 1,830 lives, eliminating an estimated 140,700 avoidable hospital days for patients.
Preventing Readmissions through Effective Partnerships (PREP) is a landmark quality collaborative between Blue Cross and Blue Shield of Illinois and the Illinois Hospital Association (IHA) to significantly reduce Illinois hospital readmissions by 2014 through redesigning hospital discharge processes. According to the Commonwealth Fund, Illinois ranks 44th in the nation with a 20.3 percent Medicare 30-day hospital readmission rate, well above the nationwide median. As part of this collaboration, more than 200 Illinois hospitals have pledged to reduce readmissions, with a goal of raising the state’s performance from the bottom quartile to the second quartile nationally.
Blue Cross and Blue Shield companies are working with hospitals to encourage them to adopt the Blue Surgical Safety ChecklistSM, a one-page tool that itemizes essential safety steps that surgical teams should perform at three key stages of surgery. In addition to sharing this checklist with hospitals and physicians, Blue companies are sharing it with their members to review and discuss with their healthcare team prior to surgery. Research published in the The New England Journal of Medicine found that hospitals that implemented the World Health Organization’s Checklist, the foundation for the Blue Surgical Safety Checklist, showed a 36-percent decrease in complications and mortality rates arising from errors in the operating room.
Harnessing technology to drive safety
Blue Cross and Blue Shield of Alabama works with the Alabama Hospital Association and more than 60 hospitals statewide through the Alabama Hospital Quality Initiative by providing tools and technology to eliminate healthcare-associated infections (HAIs). The company has underwritten most of the costs for hospitals to acquire technology that reduces HAIs by equipping clinicians with real-time, hospital-wide information that pinpoints actionable opportunities to prevent infection. Hospitals also convene quarterly to share best practices in infection prevention. The statewide initiative is estimated to have saved 316 lives and $7.8 million in 2010 by preventing HAIs in 1,520 patients and avoiding 12,152 hospital days.
The “Virtual Intensive Care Unit” is a partnership program spearheaded by CareFirst BlueCross BlueShield and Maryland eCare LLC to address a shortage of intensivists, specially trained critical care physicians, to monitor and provide care for 7,000 patients in six intensive care units (ICUs) within five hospitals throughout rural Maryland. The virtual care concept utilizes a central ICU to remotely monitor patients and coordinate care through nurses working at their respective hospitals. Early results of the program demonstrate significantly decreased patient mortality rates, length of stay and turnover of ICU staff. All participating hospitals are consistently meeting or exceeding the program goals to improve care and quality outcomes for rural Maryland residents.
Blue Cross & Blue Shield of Rhode Island’s Quality Counts program, which began in November 2005, is designed to incent primary care physicians (PCPs) to implement multifunctional electronic health record (EHR) systems in their offices. Through the initiative, the company partially funds physician practices’ EHR adoption and provides bonus payments based on mutually agreed-upon quality measures. To date, 80 PCPs have fully implemented EHRs in their practices; those that have been using EHRs for one year or more are required to write e-prescriptions for certain medications at least 60 percent of the time. Quality metrics were selected to reflect providers’ attainment or improvement in immunizations, blood pressure control, cholesterol control and preventive screening exams and are demonstrating positive results to date. For all these measures, Family Medicine and Pediatrics experienced a 44-percent improvement; Women’s Care experienced a 35-percent improvement; and Internal Medicine achieved a 24-percent improvement.
Managing pharmacy benefits to protect patients
Capital BlueCross in Pennsylvania implemented a Medication Reconciliation Outreach Referral program that focuses on patient transition from hospital to home. This program incorporates a collaborative approach between the member, a pharmacist, an outreach nurse and the company’s clinical management programs. Ninety-one percent of members surveyed felt this program helped them better understand their hospital discharge instructions, and 88 percent felt participation improved understanding of their medications. Based on the outcomes of the pilot, a comprehensive transition of care program is in place to screen 100 percent of members discharged from hospital to home for potential medication, resource or coordination of care issues.
The Blue Cross and Blue Shield Association and Blue Cross and Blue Shield companies in 24 states supported and promoted the Drug Enforcement Agency’s (DEA) National Drug Take-Back Day in 2011. The Blue System is leading efforts to increase patient safety through proper handling and disposal of unused medication. The DEA reported that the 5,361 Drug Take-Back Day sites collected 376,593 pounds of medication. That amounts to almost 500 milligrams per person in the U.S., and represents an almost 50-percent increase from the first Drug Take-Back Day in 2010.
