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Highmark's Pay-For-Performance Program Is Saving Lives and Health Care Dollars

Wednesday, December 9, 2009 Medical PDA News J E 4
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CAMP HILL, Pa., Dec. 8 QualityBLUE, Highmark's pay-for-performance program, continues to generate positive results by working with hospitals and physicians to save lives and reduce health care costs.

A number of achievements have been accomplished through the continued collaboration between Highmark and its network providers. The following results were the outcome of health care provider efforts measured by Highmark for fiscal year 2008 - 2009. A few of the Highmark QualityBLUE program highlights include the following:

MRSA Infection reduction

Approximately five patients for every 100 hospital admission results in a health care-associated infection. Many of these are caused by staph infections resistant to common antibiotics and are called Methicillin Resistant Staphylococcus aureus (MRSA). QualityBLUE hospitals reduced MRSA infections by 233 infections, which translates to a projected care cost savings of $6.3 million to $8.1 million. Approximately 5 percent of patients with a MRSA infection die, so by averting 233 infections, potentially 11 lives were saved through the work advanced by the QualityBLUE program.

Central Line Infections

A central line is an invasive catheter device inserted in a patient and used to monitor the blood circulating through the body, provide nourishment and administer medication. While these catheters are life sustaining they may place the patients at risk for infection. QualityBLUE hospitals have consistently had a lower rate of infection than the national average. Comparison of the rates demonstrates that QualityBLUE hospitals prevented 1,020 potential bloodstream infections that resulted in $37.5 million in avoided care costs, and more importantly, saved 122-255 lives.

Breast Cancer Screening

For every 1,000 women between the ages of 50 - 65 screened for breast cancer, 1.8 lives are saved. Internal medicine primary care practices participating in QualityBLUE adhered to recommended screening guidelines at a higher rate than the national average. In doing so, an estimated 174 lives in women over the age of 50 have been saved.

Generic Prescribing

It is widely reported by pharmacy benefit managers that a 1 percent increase in the generic prescribing rate provides up to 2 percent savings on total prescription costs. The cost of brand prescriptions range from $151 to $161 versus about $25 for generic prescriptions. The overall generic prescribing rate for QualityBLUE participating providers has risen from 64 percent in July 2007 to 71 percent in July 2009.

"We are very proud of our most recent results from the QualityBLUE program," said Linda Weiland, vice president of Provider Performance and Information Management at Highmark. "We have worked hard to grow and evolve our programs over the last several years and we are now realizing the positive impacts in the care delivered to many Highmark members. Our collaboration with providers is one of the key elements in the success of the program."

The Highmark QualityBLUE hospital pay-for-performance program began in fiscal year 2002 with six hospitals. Today, 52 hospitals participate in the program covering Central and Western Pennsylvania and West Virginia hospitals.

Since the inception of the program, the number of QualityBLUE hospital participants has grown to encompass more than 60 percent of Highmark's inpatient/outpatient hospital claims in the western region.

The QualityBLUE program aligns with national quality improvement organizations and utilizes standard performance measurements from industry leaders such as the National Quality Forum, Centers for Disease Control and Prevention, the American Stroke Association and the Institute for Healthcare Improvement.

About Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.8 million people through the company's health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. 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.

SOURCE Highmark Inc.
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