Highmark QualityBLUE Pay for Performance Program

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Highmark QualityBLUE Pay for Performance Program

• Building A Culture of Quality

Donald R. Fischer. MD. MBA Senior Vice President
and Chief Medical Officer April 15, 2008
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Introduction

• Why Profile Providers and Pay for Performance?
• Address consumer demands for increased
  information about provider quality safety.
• Align reimbursement with performance.
• Build performance excellence into everyday
  healthcare operations

Value
Quality
Cost
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Current Drivers of Quality Improvement

• Employers focus on Value Based Purchasing
• Continued evidence of Unwarranted Variation in
  Practice
• Consumerism
• Expansion of HEDIS indicators and NCQA
  expectations for health plans
• Federal Four Cornerstones Initiative (HHS)
• State initiatives (e.g., Rx for PA)

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Highmarks Pay for Performance Quality Mission

• Long Term Goals

Foundation
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Highmark Provider Quality Programs
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QualityBLUE Physician Program

• Performance Indicators Metrics
• Clinical Quality (16 indicators)
• Generic/Brand Prescribing
• Member Access
• Electronic Health Record
• Electronic Prescribing
• Best Practice

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QualityBLUE Physician Quality Scoring
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Clinical Quality Indicators
Family Practice, Internal Medicine, Pediatrics
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Fourth Quarter 2007 QualityBLUE Physician
Performance
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Highmark Provider Quality Programs
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QualityBLUE Hospital Participants
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Program Growth Enhancement
Alignment with National Programs

• Program Standardization
• Clinical Indicators
• Measurement and Result Expectations defined
• Provider Engagement
• Consultative relationship between hospitals and
  QualityBLUE team
• report measurement and results
• best practices implemented to improve care
• Alignment with National Programs
• Bonus opportunity approximates 3 of total
  hospital payment

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QualityBLUE Hospital Program

• Performance Indicators Metrics
• CMS Core Quality Measure Performance
• Clinical Indicator Performance
• Reduction of Methicillin Resistant Staphylococcus
  aureus (MRSA) ( IHI 5 Million Lives)
• Reduction of Central Line Associated Bloodstream
  Infections (CLAB) ( IHI 5 Million Lives )
• Medical Technology Implementation
• Surgical Care Improvement Project (SCIP)
• Infection VTE ( IHI 5 Million Lives)
• Get With The Guidelines (GWTG)
• Stroke CAD ( IHI 5 Million Lives )
• Clostridium difficile (CDAD)
• Catheter Associated Urinary Tract Infection (UTI)

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QualityBLUE Hospital Impacts Outcomes

• MRSA
• A Community Acquired Admission Cultures
• B Hospital Acquired Discharge Cultures
• C A B Combined
• 3363 people were identified as positive for MRSA
• 2,973 patients identified upon admission
  -appropriate precautions implemented as a result
  of program

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QualityBLUE Hospital Impacts Outcomes

• CLAB (2007)
• National ICU rate
• 5 infections per 1000 line days (Society of
  Critical Care Medicine)
• Rates continue to fall-Getting to Zero
• 52M savings and 375 lives saved

52 Million Saved
375 lives saved
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