Blue Cross and Blue Shield companies are dedicated to improving the quality and services available to their members, while working together to keep quality healthcare and healthcare coverage safe, affordable and accessible for all Americans. The annual BlueWorks Awards program is designed to advance that mission by recognizing the single Blue Cross and/or Blue Shield company that best demonstrates taking a leadership role in transforming the quality, affordability and delivery of care.
BlueWorks 2011 Program Winner
Office of Clinical Affairs
BlueWorks Award
Blue Cross Blue Shield of Michigan was named the winner of the 2011 BlueWorks Award for combined efforts in its Michigan Surgical Quality Collaborative and Michigan Bariatric Surgery Collaborative Quality Initiative programs.
The BlueWorks Award is given to the top program chosen from the Best of Blue Clinical Distinction Award winners that exemplifies a vision of the future of healthcare and the enormous commitment by our Blue Plan colleagues to positively impact healthcare delivery.
BlueWorks recognizes Blue Plan programs that make healthcare safe, improve care quality, accessibility and affordability, and engage providers, consumers and communities. The selection criteria, developed by the Harvard Medical School Department of Health Care Policy, include:
• Scope: Importance of the problem as determined by the perceived need and interest by the Plan, patients and providers
• Innovation: Level of innovation of the program and the extent to which the program’s success is evidence-based
• Impact: Number of Blue Cross and/or Blue Shield enrollees/providers in the Plan affected by the program and the extent to which the program improves quality and access
• Affordability: Level of cost savings realized by reducing ineffective, redundant or potentially harmful procedures
Blue Cross Blue Shield of Michigan
Michigan Bariatric Surgery Collaborative Quality Initiative
Morbid obesity has reached epidemic proportions. The number of bariatric surgical procedures performed annually has increased, prompting the need to improve outcomes, reduce complications, and address variations across hospitals and procedures. This is the foundation of the Michigan Bariatric Surgery Collaborative (MBSC), jointly sponsored by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN). The MBSC developed and implemented a clinical registry database where patient data and outcomes are collected, analyzed and shared in an effort to improve quality of care for bariatric patients in Michigan. The MBSC has focused on reducing emergency department (ED) visits and the use of pre-operative Inferior Vena Cava (IVC) filter placement. By sharing their practices, MBSC members have developed a variety of interventions to aid in decreasing their ED visit rates. The resulting cost savings is significant. Additionally, a decreased use of IVC filters was realized, resulting in substantial cost savings and improved patient safety. Collaborative efforts, including the development and implementation of best practices, have allowed MBSC to make great strides in improving the quality of care for bariatric surgery patients in Michigan. MBSC has served as a guide for other regional collaboratives and can be replicated to improve patient care in other clinical areas.
Blue Cross Blue Shield of Michigan
Michigan Surgical Quality Collaborative
The Michigan Surgical Quality Collaborative (MSQC) brings together a multi-disciplinary group dedicated to the collection and analysis of procedural and outcome data to improve quality of care for patients undergoing general and vascular surgery. The data and subsequent analysis provide the basis for reports shared quarterly with members.
MSQC presents a major opportunity for those providing surgical care to improve results and reduce complications. From the initial data reports, MSQC chose a specific focus on colectomy procedures, creating a detailed data set to perform further analysis on determinants of morbidity and mortality.
Rates for surgical morbidity are lower in the MSQC, having dropped more quickly when compared to other hospitals in the National Surgical Quality Improvement Program (NSQIP), which serves as the program’s model. The decreases in surgical morbidity rates represent fewer surgical complications and better care. In turn, substantial savings have been realized by the program and outweigh program costs.
MSQC leverages the enormous intellectual capital resulting from the collaboration of surgical leaders. Through recognition of preventable complications, the momentum of best practices can be used to improve care/reduce costs.
BlueWorks 2010 Program Winner
Patient Centered Medical Home Program
Blue Cross Blue Shield of Michigan’s Patient Centered Medical Home Program was the Award Panel’s choice for 2010’s first ever single BlueWorks Award. BCBSM’s program was chosen as the “best of the best” from the many programs submitted by Blue companies due to its performance on three key criteria:
- Research
The integrity of the research proving the size and quality of the impact of the program among its target population - Replication
The ability to replicate this program among Blue companies - Strategic Focus
The focus on improving the quality of health care for our members -- one of the key tenets of BCBSA’s Blue Vision 2015 — to improve access, keep healthcare affordable, raise the quality of care and improve consumer health.
National consensus is building in support of a new model of primary care, the Patient-Centered Medical Home. Building on the foundation of its Physician Group Incentive Program (PGIP), Blue Cross Blue Shield of Michigan launched its own Patient Centered Medical Home (PCMH) Program in 2008 to support and reward the incremental implementation of PCMH capabilities and coordinated care processes in primary care practices across Michigan. BCBSM used a two-pronged approach employing PCMH-related PGIP Initiatives and a PCMH Designation Program.
The PGIP program currently includes approximately 100 physician groups representing 8,147 providers and two million BCBSM members. BCBSM’s approach, which focuses on collaborating with physician groups which are ideally positioned to assist physicians with practice improvement, sets it apart from other PCMH programs
The fundamental approach underlying the PCMH program – partnering with providers to incrementally transform healthcare, recognizing that healthcare is local – can be adopted in any community and the goals of the program are consistent with BCBSA’s Blue Vision 2015.
Winning entries for the BlueWorks Awards program are reviewed by a panel of judges led by Barbara J. McNeil M.D., Ph.D. of the Harvard Medical School Department of Health Care Policy, and include judges representing key medical societies. The panel of judges uses a rigorous process of criteria-based evaluation to determine the program that best meets the Award criteria and makes a significant impact upon the company’s stakeholder population.
