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Blue Cross and Blue Shield Companies Recognized For Their Efforts

(CHICAGO) Programs created by BlueCross and BlueShield of Western New York (BCBSWNY) and Anthem Blue Cross and Blue Shield in Indiana, Kentucky and Ohio (Anthem) were recognized today for their efforts to improve the consistency and effectiveness of care delivered in network hospitals. The initiatives were selected by researchers at Harvard Medical School’s Department of Health Care Policy as part of BCBSA’s BlueWorks initiative – a quarterly review of innovations from Blue Cross and Blue Shield companies that are the building blocks to achieving the Blue System’s vision for a knowledge-driven healthcare system.

These programs represent a system-wide effort by Blue Cross and Blue Shield companies to work collaboratively with network hospitals to improve consistency of care for consumers. Studies by other investigators have shown that patients typically receive recommended care just 55 percent of the time.1

Both BCBSWNY and Anthem developed comprehensive, quality-focused programs designed to help participating hospitals make improvements on specific measurable performance indicators. Each program uses quality metrics to evaluate the performance of network hospitals.

“Blue Cross and Blue Shield companies believe that improving effectiveness of care for consumers begins with improving consistency nationwide,” said Scott P. Serota, President and CEO of the Blue Cross and Blue Shield Association (BCBSA). “Costs, utilization and use of evidence-based guidelines vary greatly region by region, community by community. The Blue vision for better healthcare is based on strong collaboration with providers and making knowledge work to improve the consistency and effectiveness of care.

“These programs demonstrate how strong local teamwork between insurers, hospitals and other healthcare professionals can improve care quality. If we follow the leadership demonstrated by these programs, we can start to realize better, more affordable care for consumers nationwide.”

The BlueWorks winning programs will be presented today as part of an online media briefing on hospital cost and quality and how to make knowledge work to improve care for consumers. The briefing will feature senior executives from BlueCross and BlueShield of Western New York, WellPoint, Inc. (Antehm), BCBSA and a member of the BlueWorks review team from Harvard Medical School.

BlueWorks – a unique collaboration between BCBSA and the Harvard Medical School’s Department of Health Care Policy – evaluates programs for their importance to the healthcare system, potential applicability in other communities and level of innovation.

“When measuring hospital performance, it is very important that the metrics and goals are well defined and agreed on,” said Barbara McNeil, M.D., Head of Harvard Medical School’s Department of Health Care Policy. “These programs, while having slightly different goals, were well defined and comprehensive in their scope.”

Improving consistency and effectiveness of care requires efficient use of the vast amounts of data available in the healthcare system. The Blue Cross and Blue Shield System has embarked on several national and local efforts to make this information work to benefit provider, employers and consumers. The programs from BCBSWNY and Anthem represent best practices in making knowledge work to enable doctors and hospitals to consistently deliver the best care.

BlueCross BlueShield of Western New York’s “Hospital and Physician Incentive Program” is a comprehensive quality improvement program, focused on underperforming areas at network hospitals. It was designed to address barriers to successful expansion of quality incentive programs by reducing the perception that incentive programs were an attempt to limit fee increases.

To address these concerns, BCBSWNY provided a list of agreed upon metrics, from which network hospitals selected a unique set of 4-6 clinical quality indicators, tailored to the services available at that facility and its current performance. Incentives were linked to performance on chosen measures.
Clinical quality measures in some of BCBSNY’s network hospitals showed marked improvement after the program was introduced, including reduced cardiac surgery mortality. Though the clinical and health outcomes data have been impressive, the program also has improved relationships with hospitals while helping to improve the quality of care for BCBSWNY members.

Anthem Blue Cross and Blue Shield’s “Hospital Quality Program” is a multifaceted, comprehensive quality initiative that stratifies hospitals by size to make comparison easier and more relevant. It was designed to reduce variation in practice patterns and outcomes among network hospitals. Originally launched in Ohio, the program now includes 357 hospitals in Ohio, Kentucky and Indiana.

Each participating network hospital receives an annual request for information (RFI) that consists of 10 core measures developed in collaboration with participating hospitals, accrediting bodies and quality organizations. Once the RFI is completed, data are entered into a confidential database, aggregated and analyzed. In return, hospitals receive a report card with their overall score as well as comparisons to their peer hospitals, matched by size for ease of comparison. Incentives are paid to high-performing hospitals, while lower-performing hospitals were approached in a collaborative fashion to improve the quality of care delivered.

The Hospital Quality Program has been successful in improving quality at participating hospitals. Measures such as medication interaction checks, behavioral healthcare coordination and pneumoccocal infection handling have demonstrated consistent improvements.

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