Excellus BlueCross BlueShield Awards Hospitals $21.4 Million for Quality Improvements

Fifty-three upstate New York hospitals last year earned more than $21 million in quality improvement incentive payments from Excellus BlueCross BlueShield as part of the health insurer’s Hospital Performance Incentive Program.

In the past three years, quality performance incentives from Excellus BlueCross BlueShield have exceeded $61 million.

“Collaborating with our hospital partners to link payments to improvements in health outcomes and patient safety has resulted in our members getting the best quality of care and the most value for their health care premiums,” said Carrie Frank, vice president of quality and health informatics at Excellus BlueCross BlueShield.

Eight hospitals in Central New York participated in this program in 2011, including Cortland Regional Medical Center, Crouse Hospital, Massena Memorial Hospital, Oswego Hospital, Samaritan Medical Center, St. Joseph’s Hospital Health Center and Upstate University Health System (2 hospitals).

“St. Joseph’s Hospital Health Center has found that the collaborative relationship which has evolved out of the HPIP contract with Excellus BlueCross BlueShield has improved our focus on key work processes linked to patient care outcomes,” said Sandra Sulik, M.D., vice president for medical affairs, St. Joseph’s Hospital Health Center.

Launched in 2004, the Hospital Performance Incentive Program evaluates participating hospitals on more than 300 performance measures. Target outcomes are jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, the Leapfrog Group, the Joint Commission on the Accreditation of Healthcare Organizations, the Institute for Healthcare Improvement and others.

Four areas are targeted for improvement:

• Clinical Outcomes – Focused on improvements in heart attack care, heart failure, pneumonia and surgical care.
• Patient Safety – Focused on reductions in hospital-acquired infections, improved medication reconciliation processes and National Quality Forum Safe Practices.
• Patient Perception of Care and Patient Satisfaction – Focused on a hospital’s use of a national survey tool.
• Efficiency – Focused on generics utilization, length of stay and readmissions.

“The hospitals participating in our performance incentive program have seen higher scores on their CMS Quality Measures than hospitals whose payments are not at-risk,” said Frank. CMS is the federal agency which administers Medicare, Medicaid and the Children’s Health Insurance Program.

Relevance in upstate New York
In 2007, Excellus BlueCross BlueShield issued a fact sheet on hospital-acquired infections that showed an estimated 19,500 upstate New Yorkers acquired an infection during a hospital stay in 2004, and nearly a thousand deaths were likely to have occurred as a result. The fact sheet, titled Hospital-Acquired Infections in Upstate New York, is archived under the heading “Hospitals” in the News & Information section of excellusbcbs.com