1 / 16

highmark qualityblue pay for performance program

2. Introduction. Why Profile Providers and Pay for Performance?Address consumer demands for increased information about provider quality

oshin
Download Presentation

highmark qualityblue pay for performance program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. 1 Highmark QualityBLUE Pay for Performance Program Building A Culture of Quality

    2. 2

    3. 3 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)

    4. 4 Highmark’s Pay for Performance Quality Mission Long Term Goals

    5. 5 Highmark Provider Quality Programs

    6. 6 QualityBLUE Physician Program Performance Indicators & Metrics Clinical Quality (16 indicators) Generic/Brand Prescribing Member Access Electronic Health Record Electronic Prescribing Best Practice

    7. 7 QualityBLUE Physician Quality Scoring

    8. 8 Clinical Quality Indicators

    9. 9 Fourth Quarter 2007 QualityBLUE Physician Performance

    10. 10 Highmark Provider Quality Programs

    11. 11 QualityBLUE Hospital Participants The Highmark QualityBLUE Hospital Pay for Performance Program was begun in FY 2002 with six select hospital participants. The program has expanded throughout the years and now incorporates thirty facilities, including healthcare organizations from the western and central regions of Pennsylvania. The Highmark QualityBLUE Hospital Pay for Performance Program was begun in FY 2002 with six select hospital participants. The program has expanded throughout the years and now incorporates thirty facilities, including healthcare organizations from the western and central regions of Pennsylvania.

    12. 12 Program Growth & Enhancement 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

    13. 13 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)

    14. 14 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

    15. 15 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

    16. 16

More Related