Highmark's Quality Blue Hospital Program Works With Health Care Providers to Improve Quality For Members

Nov 06, 2013, 10:00 ET from Highmark Inc.

PITTSBURGH, Nov. 6, 2013 /PRNewswire/ -- Highmark Inc. today released results from the company's Quality Blue Hospital Pay for Performance program that demonstrates clinical outcome improvements by hospitals in Western and Central Pennsylvania and West Virginia in many different areas. "We have an extraordinary level of commitment from the hospitals in Highmark's network," said Paul Kaplan, M.D., senior vice president of Provider Integration and Strategy for Highmark. "The year over year improvements demonstrates that the program has been and continues to be very successful. Patient safety and quality issues in our hospitals are long-term and complicated. They don't have quick fixes. One of the best attributes of this program is the long-term committed partnership between Highmark and our hospitals.

Some of the improvements during the past year include:

Infection Prevention

The Quality Blue Hospital Pay for Performance Program has focused on reducing and eliminating hospital infections. Central line-associated bloodstream infections (CLABSI) occurred at lower rate at hospitals that participated in the Quality Blue program than national rates based on  infection rates documented by the Centers for Disease Control and Prevention (CDC).

As a result, Highmark Quality Blue hospitals have experienced 1853 fewer CLABSI than what would be expected at the national rate.  With mortality rates between 12-25 percent for these adverse events, this represents a potential 222-463 fewer deaths compared to the national rate.  


Reducing avoidable hospital readmissions is an opportunity to improve quality and reduce costs. These readmissions are disruptive to patients and put them at additional risk for infections and complications.

Hospitals that participated in the Quality Blue readmissions portion of the program for four consecutive years showed a decrease of nearly 3 percent for 7-day inpatient readmissions. Those same hospitals also showed a nearly 5 percent decrease in 30-day readmissions.

The readmission indicator has encouraged hospitals to reach out into their communities and work collaboratively with caregivers, physician practices and facilities, to ensure that patients' needs are being met across the continuum.  Many of the Highmark Quality Blue hospitals have set up ongoing meetings with these facilities, to discuss the needs of high-risk populations, provide education on evidence based practices and to share data. 

Heart Failure

Comparing rate of "defect free care" for heart failure patients, Quality Blue hospitals provided defect free care at a rate of 76.2 percent defect free care compared to the national rate of 60.4 percent.  This means that 193 more Quality Blue hospital's patients received Heart Failure defect free care improving chances for reduced morbidity and mortality.

During the past year 102 hospitals in Pennsylvania and West Virginia participated in the Quality Blue Hospital Pay for Performance program. Together with the Quality Blue Patient-Centered Medical home (PCMH) program  and the Quality Blue Accountable Care Alliance (ACA) Program, Highmark will continue to emphasize ways to support hospitals and physicians as they improve quality and patient safety while lowering health care costs.

On Friday, Nov. 8, Highmark will host its annual Quality Blue Best Practices Forum where hospitals from around Pennsylvania and West Virginia will share best practices in quality care and patient care. "This is one of the best forum's of its kind in the country. Hospitals that may compete all year, share data at this forum to improve patient care and safety across all institutions. We are extremely pleased to convene all of our participating hospitals with a focus on improving the quality of care for our members," said Kaplan.

SOURCE Highmark Inc.