Quality-In-Sights

Anthem Blue Cross and Blue Shield in Virginia

Choosing clinical measures on which to provide incentives is a difficult and possibly divisive task for a health plan considering a pay-for-performance program.  Partnering with relevant professional societies and using data collected by these third parties gives this quality improvement program strong credibility for participating physicians.

Program Elements:

• Anthem Blue Cross and Blue Shield in Virginia introduced their Quality-In-Sights^® Hospital Incentive Program (Q-HIPsm) in 2003.  The program was designed to collect data from network hospitals and provide feedback on key quality and safety metrics. 

• Participating hospitals receive an annual "scorecard" of hospital-specific results and comparison to peer hospitals. 

• Anthem launched the Quality Physician Performance Program (Q-P3sm) in 2006 to compliment and strengthen Q-HIP.  Like Q-HIP, the Q-P3 program incorporates outcome, process and quality measures to reward evidence-based medicine and other best practices.  Q-P3 was made available to cardiologists and cardiac surgeons.

• The data used in the Cardiology and Cardiac Surgery Q-P3 are a combination of data received through annual Q-HIP reporting and data from national registries.  Q-P3 guidelines for Cardiology were developed in collaboration with an expert panel of practicing cardiologists from the Virginia chapter of the American College of Cardiology (ACC).  Similarly, Q-P3 guidelines for Cardiac Surgery were developed with input and consideration from The Society of Thoracic Surgeons (STS)

• The ACC has created the National Cardiovascular Data Registry, which allows hospitals to compare their performance on ACC measures with other hospitals across the country.  In further conversations, Anthem partnered with The Society of Thoracic Surgery (STS) to develop, measure, and assess performance for Q-HIP and Q-P3 using data provided by the STS.

Program Results:

• Q-HIP has been successful in creating "quality competitiveness" among participating hospitals and has been expanded from 16 pilot hospitals to include 63 hospitals in Virginia serving over 90% of Anthem members admitted to inpatient care in 2006.

• Based on data provided by the first 8 hospitals to have participating cardiologists and cardiac surgeons, program results were encouraging.  Complication rates in 2004 for angioplasty and cardiac catheterization decreased 50 and 29 percent, respectively from 2003 levels. 

• Rates of balloon angioplasty meeting ACC guidelines for an acute cardiac event improved by 17% in the same time period, once again exceeding national averages.

Contact 

Lindsey Gilbert, Director, Network Performance, 804-354-7377, lindsey.gilbert@anthem.com