Highmark Says Quality Blue Program Saves Lives, Dollars

Donovan says the improvements are particularly impressive because Quality BLUE constantly monitors and improves its own standards. "The program is modified each year to increase the rigor. We raise the bar each year and the facilities continue to be challenged and work hard to achieve the outcomes," she says.

Even patients who aren't in the PFP program are enjoying the benefits of the enhanced quality at participating hospitals, Donovan says. "When we operationalize the program, it applies to any patient who crosses the threshold of a facility's door."

"It is Highmark's program that is really creating the infrastructure requirement and changes in the institutions. That change is applicable whether it is a standard Medicare patient or another health insurer. They are receiving the benefit of the changes that the Quality Blue program helps drive within the institution," she says.

Because the program is adjusted annually, providers are required to implement the newest strategies quickly to improve and measure outcomes in a well-defined way. "That way we can look at that consistent measure across all facilities, and then compare ourselves to external benchmarks," Donovan says.

Highmark's next move with Quality Blue will be to take the lessons learned in the PFP program and apply them to other care delivery models, including a newly launched patient-centered medical home pilot serving Pennsylvania and West Virginia. "We are continuing to look at how do we advance value-based models that will improve the care that is being rendered to our members and ultimately bend the cost trend," she says. "If we can't bend the trend, then it is not going to be sustainable in the long term."