Highmark's Quality Blue Hospital And Physician Program Continues Efforts To Improve The Quality Of Care And Reduce Health Care Costs
November 7, 2012
PITTSBURGH — Highmark Inc. released results today from its Quality Blue hospital program that demonstrate impressive gains as it continues to work with network hospitals to improve quality and patient care. "There were a number of areas that continue to improve, including reducing preventable infections, complications and unnecessary readmissions," said Linda Weiland, Highmark's vice president of provider network innovation and partnerships. "As one of our signature programs, it emphasizes collaboration with our network providers."
Some of the key findings from Highmark's report include:
Quality Blue Hospital Pay for Performance — Readmissions
Reducing readmissions is a complex process that requires multiple system changes throughout an organization over a long period of time. Readmissions are often avoidable and reflect issues with quality and care coordination. For the 10 hospitals that are three-year participants, the 30-day inpatient and observation readmission rates showed a statistically significant decrease in 2012 compared to 2011. For every 100 patients discharged, there were 14.32 readmissions in 2011, which decreased to 13.93 in 2012.
Approximately 500,000 surgical patients develop surgical site infections each year across the country. The Quality Blue hospital program encourages the use of the World Health Organizations (WHO) surgical safety checklist as a means of ensuring that critical safety steps are taken before, during and after surgery to minimize avoidable risks. In 2012, 29 hospitals participated in the surgical safety indicator. Combined, 739 inpatient and outpatient surgical site infections were averted. At a low-end cost of $2,734 per infection, this represents potential savings of more than $2 million
The Highmark Quality Blue hospital program continues to focus on several infections, including central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI) and infections caused by specific bacteria, including Clostridium difficile (C-diff) and Methicillin Resistant Staphylococcus aureus (MRSA). For these indicators during the past five years, 2,527 infections were potentially averted with potential savings of more than $43 million. Specifically, in 2012, 173 CLABSIs and 205 CAUTI were potentially averted.
The Quality Blue program attempts to facilitate data submission requirements through the use of existing state and national resources, including data submitted to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), The Centers for Medicare and Medicaid Services (CMS), The Joint Commission and the Pennsylvania Department of Health.
Quality Blue Physician Pay for Performance — Generic Prescribing
Prescription drug spending in the U.S. reached $307 billion in 2010, an increase of $135 billion since 2001, comprising approximately 12 percent of all health care spending in the country, according to the Government Accounting Office.
The prescribing of clinically appropriate generic drugs is one of the most successful methods for reducing costs while delivering high-quality care. Providers continued to improve generic prescribing rates from the 2006 low of 46 percent to 79 percent in 2012 while the national rate has remained at 67 percent since 2011. The 2012 generic prescribing rate increased by three percentage points compared to 2011.
By the age of two years, healthy children should have multiple well-child care visits that include screening and immunizations. Physicians that participated in Quality Blue exceeded national standards for childhood immunization rates and well child care visits. Physicians used electronic medical record alerts to identify missed appointments, needed vaccinations and gaps in preventive care.
Highmark's Quality Blue hospital program began in 2002 and has now expanded to 91 hospitals in Pennsylvania and West Virginia. Highmark will begin including hospitals in Delaware in 2014. The physician program now engages nearly 4,600 physicians that provide care to 1.7 million Highmark members.
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. Highmark serves 4.9 million members in Pennsylvania, West Virginia and Delaware through the company's health care benefits business and is one of the largest Blue plans in the nation. Highmark has 20,000 employees across the country and provides a broad range of health and wellness related services through subsidiary and affiliate companies. For more information, visit www.highmark.com.
The Blue Cross and Blue Shield Association is a national federation of 37 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for nearly 105 million members – one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.