Excellus BlueCross BlueShield Awards Hospitals $26 Million for Quality Improvements

Forty-five upstate New York hospitals and health centers last year earned $26 million in quality improvement incentive payments from Excellus BlueCross BlueShield as part of the health insurer’s Hospital Performance Incentive Program. In the past 10 years, quality performance incentives from Excellus BlueCross BlueShield have exceeded $197 million.

“We applaud our hospital partners, not only for their willingness to collaborate with our health plan on methods and measurements to improved health outcomes and patient safety, but also for tying those outcomes to a financial incentive to drive focus in mutually agreed upon quality goals,” said Carrie Whitcher, vice president clinical quality at Excellus BlueCross BlueShield.

Participating in this program in 2014 were eight Central New York hospitals, including Auburn Memorial Hospital, Cortland Regional Medical Center, Crouse Hospital, Oswego Hospital, Samaritan Medical Center, St. Joseph’s Hospital Health Center and Upstate University Health System (2 sites).

“Partnering with Excellus BlueCross BlueShield allows both organizations to achieve shared goals of improved community health through working together,” said Jennifer Watkins, Director, Quality Improvement, Crouse Hospital. “Participation in the Hospital Performance Incentive Program has provided us opportunity for increased education, resources and the ability to network with peers facing similar hurdles to success.”

Launched in 2004, the Hospital Performance Incentive Program evaluates participating hospitals on more than 247 performance measures. In 2014, hospitals achieved 88 percent of all target quality levels. In addition to required clinical and patient safety measures, other nationally endorsed measures and target outcomes are jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, The Joint Commission, the Institute for Healthcare Improvement and others.

Areas targeted for improvement include:

• Clinical Processes of Care – Focused on improvements in heart attack care, heart failure, pneumonia and surgical care, and other measures that may be unique to each participating hospital.
• Patient Safety – Centered on reductions in hospital-acquired infections, falls, pressure ulcers, readmissions and other adverse events or errors that affect patient care.
• Patient Satisfaction – Using the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.

Relevance in upstate New York
(From the Excellus BlueCross BlueShield Spring 2013 fact sheet on Hospital-Acquired Infections in Upstate New York)

In 2010, New York state reported about 108,000 hospital-acquired infections, including 24,000 in upstate New York. Those hospital-acquired infections led to an estimated 5,000 New York state deaths, 1,100 of which were in upstate New York.

If upstate New York hospitals could lower the number of hospital-acquired infections by even 20 percent or 40 percent, there would be an estimated 5,000 to 10,000 fewer infections and 200 to 400 fewer associated deaths, the Excellus BlueCross BlueShield report concludes. That would also save upstate New York hospitals an estimated $68 million to $137 million annually.