Highmark's Quality Blue Program Helps Hospitals Reduce Readmissions And Infections For Members

PITTSBURGH – Hospital pay-for-value programs continue to reap health benefits for their members, according to Highmark Inc.'s 2014 Quality Blue program results.

After four years of tracking hospital readmissions, the Quality Blue program has helped to avert 2,900 readmissions, with a potential cost savings of $27.7 million. Following eight years of monitoring health care-associated infections, Quality Blue has helped to prevent 5,630 infections, with a potential cost savings in the range of $34.8 million to $109.4 million.

"We began our Quality Blue program in 2002 because we sincerely believed, amid some skepticism, that we could work with hospital partners to improve the quality of patient care while reducing the cost of care," said Paul Kaplan, M.D., senior vice president of provider integration and strategy for Highmark. "Our data for 2014 demonstrate that substantially improving care and safety translates not only to a better quality of life for patients but also to cost savings for all parties — our members, their employers, the hospitals and the insurer."

In 2014 alone, the hospital-insurer collaboration helped to avert 754 readmissions, with a potential cost savings of $7.2 million. In addition, 1,267 health care-associated infections were prevented, resulting in a potential cost savings of $5.7 million.

The following are highlights of the Quality Blue program's results as of December 31, 2014:


  • The rate of returns to the emergency room within 48 hours of discharge decreased by nearly 7 percent.
  • From 2011 to 2014, 30-day readmission rates decreased by more than 3 percent.

Patient Care

  • Seven-day follow-up care after discharge for heart failure patients improved by 72 percent; for stroke patients, 17 percent.
  • For end-of-life care, hospitals following protocols improved by nearly 44 percent.
  • Elective labor inductions at less than 39 weeks gestation decreased by 37 percent. (Reducing early elective inductions can reduce harm to both mothers and babies.)
  • Compliance with sepsis protocols improved by 37 percent. (Early detection of sepsis and quick intervention can reduce patient deaths.)
  • Risk screening for pre-surgical anemia increased by 32 percent.


  • Catheter-associated urinary tract infections (CAUTI) declined by 8 percent.
  • Clostridium difficile infections (CDI, or C. diff) decreased by 40 percent. (CDI can lead to colitis and severe diarrhea.)
  • Central line-associated blood stream infections (CLABSI) dropped by 31 percent.
  • Outpatient surgical site infections (SSI) decreased by 37 percent; inpatient SSI declined by more than 4 percent.

Highmark's 13-year-old Quality Blue hospital program has grown to include 102 hospitals.

About Highmark Inc.
Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.

About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit BCBS.com. We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.