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Health Plan Helps Hospitals Achieve Better Grades

Joe Cantlupe, for HealthLeaders Media, March 17, 2010

Hospitals sometimes face issues that CEOs wouldn't like to brag about. There may be lapses in quality of care, such as hospital-based infections or failure to adhere to treatment guidelines.

A hospital may fall below optimal standards, despite the fact that the facility may be working diligently at quality improvement.

When hospitals face these issues, they don't often look to a health plan for help, but that's the case in California.

An evolving pilot program in the Golden State involves a health plan, Blue Shield of California; and a hospital system, Adventist Health as well as the California Health Care Coalition (CHCC), a membership organization of public and private sector employers, unions, employer organizations, and health & welfare trust funds representing 4 million Californians.

Under the three-year pilot program, the hospital, providers, and payers are looking to improve healthcare quality and trim costs, and all the while, working together. That's the goal at least.

They are doing this in their own neighborhood, without waiting for Congress, or the President or anybody in Washington, DC, telling them how to improve patient care. This pilot represents an interesting scenario, and we should all watch how it unfolds.

The planning began in 2007, when Blue Shield and CHCC began talking about a coordinated pilot to improve quality, while lowering costs. Blue Shield and CHCC signed an agreement to run the Hospital Quality Improvement Pilot and find a hospital to work with them.

The CHCC had been concerned that there was a "disconnect" between high costs and the actual quality of care in California hospitals. The costs were going up, that's for sure. And what about that quality of care? Was it inconsistent?

"Our goal was to work in local markets and improve quality as a means to reduce overall healthcare costs," says Michael O'Neil, Blue Shield of California's director of healthcare value.

Specifically, Blue Shield was looking at California's central valley. "We looked at what would be an appropriate provider partner and Adventist came to the top of the list."

The Adventist healthcare system includes 17 hospitals, 14 home care agencies, and four joint-venture retirement centers.

Adventist wasn't selected because the healthcare system was rated at the top. Or that it was solidly even in its performance.

The hospitals' report cards yielded grades that showed there were needed improvements, according to Blue Shield and Adventist officials. A 90% score judged by the California Hospital Assessment & Reporting Task Force means that the hospital has achieved top 10% scores. That is what Adventist wants.

Hospital officials say there are some elements in Adventist's healthcare delivery system rated highly, but others were average, and some fairly low. Generally, there are specific areas of care or documentation that are cited for needed improvement.

"They do have a wide variation in their quality scores," says O'Neil, referring to Adventist. "But over the past several years, they have been working really diligently to improve quality internally and have been working with Johns Hopkins University. We felt there was good synergy about this."

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