Highmark’s Pay-For-Performance Program Saved Lives and Health Care Dollars in 2010-2011

Nov. 3, 2011 | Pittsburgh, Pa. — Highmark’s latest data on its Quality BLUE pay-for-performance programs demonstrates that participating hospitals and physicians consistently take better care of Highmark members than health care providers that are not part of the program.

“Whether you look at infection rates, screening for various diseases or electronic prescribing rates, Highmark members are getting better care from providers that are part of the Quality BLUE program,” said Linda Weiland, vice president of provider network innovations and partnerships. “We see very clear patterns of improved patient safety and clinical care for our members.”

Highmark today released its annual Quality BLUE report which provides data from fiscal year 2011 on both the hospital and physicians pay-for-performance programs. Some of the major findings include the following:

  • Well-child visits in the first 15 months of life exceeded the national average by 15 percent and well-child visits for children, ages 3 -6, exceeded the national average by 13 percent.
  • Seventy-six percent of female members age 42 to 69 received mammography screening for breast cancer from Highmark providers in the past two years. This is a full nine percent higher than the national average.
  • Seventy-two percent of office-based physicians in Quality BLUE use electronic prescribing compared to only 36 percent nationally. Electronic prescribing improves patient safety and reduces errors. It also improves efficiency and cost savings.
  • An estimated 351 cases of MRSA with a care cost savings estimated between $9.5 million – $12.2 million were eliminated during the past four years. MRSA is an antibiotic-resistant organism, which can cause potentially life-threatening bloodstream and surgical site infections in hospitals and community settings. Through the Quality BLUE hospital program, hospitals provide MRSA education to patients and family members.
  • An estimated 1,535 central line associated bloodstream infections (CLAB) with care costs savings of $11.2 million to $44.8 million were eliminated in all nursing units, not just intensive care units, during the last five years, saving potentially 184-384 lives. A central line is a catheter inserted into a large vein close to the heart to monitor blood circulation, provide nourishment and administer fluids and medication. While these catheters are life sustaining, they put patients at risk for infection.

 

The Highmark Quality BLUE hospital pay-for-performance program began in fiscal year 2002 with six hospitals. By fiscal year 2011, program participation grew to 63 hospitals and today includes 81 hospitals.

Highmark’s Quality BLUE physician program is offered in 49 counties in Western and Central Pennsylvania, with approximately 6,300 PCPs in more than 1,600 practices, providing services to more than 1.7 million Highmark members. Sixty-six percent of all primary care practices participate in the Quality BLUE program.

“During the past decade we know this program has greatly improved patient safety and saved millions of dollars,” said Weiland. “At Highmark we continue to push for paying for quality in health care and not just paying for services.”

About Highmark
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.8 million members in Pennsylvania and West Virginia through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 19,500 employees across the country. For more than 70 years, Highmark’s commitment to the community has consistently been among the company’s highest priorities as it strives to positively impact the places where members call home. For more information, visit www.highmark.com.

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit www.highmark.com.

 

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