Quality Blue Patient-Centered Medical Home Program

Program Location: 
Philadelphia, PA
Number of Practices: 
300
Payer Type: 
Commercial
Payers: 
Highmark Health Services (BCBS)

Reported Outcomes

Description: 

In October 2012, Highmark launched both the Quality Blue Patient-Centered Medical Home and the Quality Blue Accountable Care Alliance (ACA). The ACA builds on the Patient-Centered Medical Home concept of patient-centered care coordinated by a primary care physician but adds a dimension of closer care coordination with specialists, hospitals and other health care facilities. Providers who participate in the ACA are able to lay the groundwork for becoming a full-fledged accountable care organization as our program becomes available.

Quality Blue Patient-Centered Medical Home continues to successfully recruit providers in central and western Pennsylvania and West Virginia. The Highmark Quality Blue Physician Program recognizes and financially rewards Primary Care Physicians (PCPs) who work collaboratively with Highmark to improve quality and effectiveness of health care for Highmark members. PCP practices (Family Practice, Internal Medicine, and Pediatrics) that participate are measured on several quality and efficiency indicators, which drive the overall member quality improvement. The main focus is clinical quality where patients receive evidence -based-care in accordance with nationally recognized guidelines.

Payment Model: 

Under this model, the payment system is also beginning to change with physician practices and Highmark having risk involved. If there are not cost savings, there are not enhanced payments to physicians.

Fewer ED / Hospital Visits: 

Hospitals that participated in the Quality Blue readmissions portion of the program for four consecutive years showed a decrease of nearly three percent for 7-day inpatient readmissions. Those same hospitals also showed a nearly five percent decrease in 30-day readmissions.

As of December 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
Improved Health: 
  • 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.
Cost Savings: 
  • 5% decrease in total PMPM costs for coronary artery disease patients 
  • 3.5% decrease in total PMPM costs for diabetics 
  • Nearly a 2% decrease in overall health care costs 
Last updated March 2019
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