Highmark's Quality Blue Hospital Program Works With Health Care Providers To Improve Quality For Members

Highmark Inc. today released results from the company's Quality Blue Hospital Pay for Performance program that demonstrates clinical outcome improvements by hospitals in western and central Pennsylvania and West Virginia in many different areas. "We have an extraordinary level of commitment from the hospitals in Highmark's network," said Paul Kaplan, M.D., senior vice president of Provider Integration and Strategy for Highmark. "The year over year improvements demonstrates that the program has been and continues to be very successful. Patient safety and quality issues in our hospitals are long-term and complicated. They don't have quick fixes. One of the best attributes of this program is the long-term committed partnership between Highmark and our hospitals."

Some of the improvements during the past year include:

Infection Prevention
The Quality Blue Hospital Pay for Performance program has focused on reducing and eliminating hospital infections. Central line-associated bloodstream infections (CLABSI) occurred at lower rates at hospitals that participated in the Quality Blue program than national rates based on infection rates documented by the Centers for Disease Control and Prevention (CDC).

As a result, Highmark Quality Blue hospitals have experienced 1853 fewer CLABSI than what would be expected at the national rate. With mortality rates between 12-25 percent for these adverse events, this represents a potential 222-463 fewer deaths compared to the national rate.

Reducing avoidable hospital readmissions is an opportunity to improve quality and reduce costs. These readmissions are disruptive to patients and put them at additional risk for infections and complications.

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.

The readmission indicator has encouraged hospitals to reach out into their communities and work collaboratively with caregivers, physician practices and facilities to ensure that those patients' needs are being met across the continuum. Many of the Highmark Quality Blue hospitals have set up ongoing meetings with these facilities to discuss the needs of high-risk populations, provide education on evidence based practices and to share data.

Heart Failure
Comparing rates of "defect free care" for heart failure patients, Quality Blue hospitals provided defect free care at a rate of 76.2 percent defect free care compared to the national rate of 60.4 percent. This means that 193 more Quality Blue hospital's patients received heart failure defect free care improving chances for reduced morbidity and mortality.

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