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Broker News | Vol. 8, No. 4 | February 22, 2013
Broker News | Vol. 8, No. 4 | February 22, 2013

Excellus BCBS Awards Hospitals $26 Million for Quality Improvements

Fifty-four upstate New York hospitals and health centers last year earned $26 million in quality improvement incentive payments from Excellus BlueCross BlueShield as part of their Hospital Performance Incentive Program (HPIP). In the past nine years, quality performance incentives from Excellus BCBS have exceeded $145 million.

“Our many years of working with our hospital partners to drive improvement in quality of care and patient safety by linking payments to improvements in health outcomes provides a strong foundation for the new models of collaboration anticipated with health care reform," said Carrie Frank, vice president of quality and health informatics at Excellus BCBS. 

“By aligning our quality improvement efforts with those of Excellus BlueCross BlueShield, we’ve been able to enhance the level of care delivered to our patients,” said Kiera Champlin-Kuhn, RN, patient safety officer, and director of quality, safety and utilization management at Thompson Health in Canandaigua.

Launched in 2004, the HPIP program evaluates participating hospitals on over 300 performance measures. In 2012, hospitals achieved 87 percent of all target quality levels. Target outcomes are jointly agreed upon by each hospital and the health insurer using benchmarks established by the CMS, the Leapfrog Group, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Institute for Healthcare Improvement (IHI), and others.

Four areas are targeted for improvement:

  • Clinical Outcomes – Focused on improvements in heart attack care, heart failure and pneumonia care
  • Patient Safety – Focused on reductions in hospital-acquired infections, improved medication reconciliation processes, surgical care and National Quality Forum Safe Practices
  • Patient Perception of Care and Patient Satisfaction – Focused on a hospital’s use of a national survey tool
  • Efficiency – Focused on generics utilization, length of stay, and readmissions

"The Health Plan has continued to advance the program whereby hospitals are now required to measure surgical and clinical care composites as hospital contracts open for negotiation,” said Frank. “It is anticipated that this focus will further drive performance improvement to national performance levels in important measures as identified by CMS.*"

Relevance in upstate New York 

According to the most recent data on hospital-acquired infections available from the Centers for Medicare & Medicaid Services, an estimated 24,000 upstate New Yorkers acquired an infection during a hospital stay in 2010 and more than 1,000 deaths were likely to have occurred as a result.

*CMS is the Centers for Medicare and Medicaid Services and is the US federal agency which administers Medicare, Medicaid, and the Children's Health Insurance Program.

 

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