Why is a major health insurer conversing with hospital systems in Pennsylvania to discuss performance on quality measures? They are discussing reimbursement incentives as participants in Highmark Inc.’s QualityBLUE pay-for-performance program.
Highmark was established in 1996 when two Pennsylvania licensees of the Blue Cross Blue Shield Association consolidated, now called Highmark Blue Cross Blue Shield, and is one of the largest health insurers in the U.S. Impressively, Highmark’s latest press release involving it’s QualityBLUE Program show results consistently supporting participating hospitals and physicians take better care of their members than those health providers not participating in the program saving money and lives.
Highmark QualityBLUE Program aims to align reimbursements with performance in order to build excellence in quality. Participating hospitals are rewarded using evidenced-based practices focusing on health issues that will strongly make an impact on patients in Pennsylvania and West Virginia.
How QualityBLUE Works:
QualityBLUE’s participating hospitals risk a certain percentage of their reimbursement for the coming year, in this case 1-3%. If the hospital meets 100% of the quality measures they’ve identified such as: bloodstream infections, bacterial infections and other hospital acquired complications, then the hospital will be fully reimbursed. But if the hospital receives a score of 70 or below, no reimbursement is attached.
Results to Date:
In light of their efforts, participating hospitals have seen significant decreases in rates for adverse events they’ve identified and focused on compared to national rates.
Highlights:
• Between $9.5 million - $12.2 million in costs were reduced for MRSA, an antibiotic-resistant organism which can potentially cause life-threatening infections.
• In the last five years an estimated 184 to 384 lives were saved resulting in cost care savings of $11.2 million to $44.8 million for central line associated bloodstream infections.
• 76% of female members ranging from 42 to 69 years of age received mammography screenings for breast cancer in Highmark providers just in the last two years. 9% greater than the national average.
While the Highmark QualityBLUE program is not the first health insurance company working with hospitals to tie performance with payment incentives, the program prides itself on its coordination. Hospital and insurance officials collaborate twice a year to review their hard work and the information is shared with everyone involved in the healthcare process. This approach creates transparency, a culture surrounding quality and a set of priorities so patients will receive the right type of care at the right time.
When the Highmark QualityBLUE program first began in 2002, only 6 hospitals were participating. After seeing effective results, 63 hospitals now participate. By 2012, Highmark officials believe 81 hospitals will participate and as the results appear more profound, more hospitals are expected to join.
You may view Highmark’s press release in its entirety here.
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