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Highmark Says Quality Blue Program Saves Lives, Dollars

John Commins, for HealthLeaders Media, November 4, 2011

After a decade of documenting, Highmark, one of the nation's largest Blue Cross and Blue Shield affiliates, says physicians and hospitals in its Quality BLUEpay-for-performance initiatives consistently outperform providers who are not part of the program.

In its annual report for fiscal 2011, Highmark says Quality BLUE has used financial incentives to lower healthcare-acquired infection rates—saving hundreds of lives and tens of millions of dollars—and improve screening rates and overall patient safety. The quality measures continue to improve even as the program has grown to include 1.7 million Highmark members, 81 hospitals, and 1,600 practices in 49 counties in central and western Pennsylvania.

Deb Donovan, director of provider performance and strategy at Pittsburgh-based Highmark, told HealthLeaders Media that the secret to the PFP model is simple.

"Frankly, it is skin in the game," Donovan says. "The hospitals place a portion of their contracted reimbursement at risk on performance in the program, and there is enough money at risk for the organization that it gains the C-suite's attention. It quickly galvanizes the organization around aligned goals and helps drive clinical improvements."

Donovan points to several key metrics in 2011 for both hospital and physician PFP programs:

  • Well-child visits in the first 15 months of life exceeded the national average by 15% and well visits for children, ages 3-6, exceeded the national average by 13%.
  • 76% of women in the program who were between ages 42 and 69 got mammography screenings for breast cancer in the past two years—9% higher than the national average.
  • 72% of office-based physicians in Quality BLUE use electronic prescribing compared to only 36% nationally.
  • An estimated 351 cases of MRSA with a care cost savings of $9.5 million to $12.2 million were eliminated in the past four years.
  • An estimated 1,535 central line associated bloodstream infections with care costs savings of $11.2 million to $44.8 million were eliminated in the last five years, saving potentially 184-384 lives.
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