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Highmark trumpets strides of decade-old Quality Blue program

| Thursday, Nov. 8, 2012, 12:01 a.m.

Highmark Inc. on Wednesday touted the results of its 10-year-old Quality Blue program, which pays hospitals based on improving quality.

Several initiatives to reduce hospital-acquired infections have saved about $45 million in unnecessary medical spending since 2007, Highmark officials said.

“There were a number of areas that continue to improve, including reducing preventable infections, complications and unnecessary readmissions,” said Linda Weiland, Highmark's vice president of provider network innovation and partnerships.

There are 91 hospitals across Pennsylvania and West Virginia participating in the optional Quality Blue program. Typically, 1 percent to 3 percent of their total annual reimbursement is tied to improving quality, Weiland said.

“We are approaching in 2013 close to $100 million in total reimbursement” that is tied to reducing hospital-acquired infections, hospital readmissions, and other issues, Weiland said.

Nine out of 10 hospitals in the state participate in some kind of quality program like Quality Blue, said Gary Tuma, spokesman for the Pennsylvania Health Care Cost Containment Council, an independent state agency that collects health care cost and quality data.

“It's a trend,” Tuma said, “and it's largely because people see it as an area with great potential for quality improvement.”

While it might not be possible to avoid all infections and readmissions, Tuma said, “A significant portion are preventable.”

Highmark said hospitals in Quality Blue have focused on reducing several types of preventable infections, including bloodstream infections from intravenous lines, urinary tract infections from catheters and infections from two bacteria that are commonly picked up in hospitals. Between 2007 and 2012, the effort yielded 2,527 fewer of those infections, saving $43 million, the insurer said.

Infections of surgical sites also is a common problem, Highmark said. Hospitals focused on it were able to prevent 739 infections between 2011 and 2012, Highmark said, saving more than $2 million.

Readmissions of patients in 30 days or less after a discharge also are an avoidable problem, Highmark said. Quality Blue showed a 2.7 percent decrease in readmissions between 2011 and 2012.

Highmark announced in July that it would begin requiring all 91 of the participating hospitals to track and reduce readmissions. It was previously an option under Quality Blue.

“It seems that certainly they're headed in the right direction,” Tuma said of the results. “It does seem to be paying off for them.”

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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