This was a public presentation of the hospital quality improvement program I managed when I was at BCBSMA. It was delivered at the IHI Conference in 2005

1. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
Hospital Quality
Improvement Program
BCBSMA Presentation to IHI
December 13, 2005
IHI – BCBSMA Agenda
1. Brief history of BCBSMA and HQIP
2. Review of Current Approach to HQIP
3. Latest HQIP Results
4. Discussion of Role of Health Plan in Hospital QI
5. Future of HQIP
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2. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA History
A Decade-Long Commitment to Drive
Quality Improvement
• 2.8 million members
• Array of products – HMO, POS, PPO, Indemnity, Dental
• Steady growth for past decade
• Financial stability
• NCQA accredited at Excellent level
• Listed in US News & World Report Honor Role / Top 10
• Recent shift in focus to driving external QI
BCBSMA Goals
Corporate Promise: We will always put our
members’ health first.
Corporate Goals:
1. To improve the health of our Members;
2. To improve the quality of care our Members receive;
3. To build world-class Member loyalty;
4. To achieve profitable growth and moderate the health care
cost trend; and
5. To be an outstanding corporate citizen and community
leader.
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3. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA History
Incentives to Drive External QI
• PCPIP program in place for five years
• GPIP Beat the Trend initiated in 2003
• Public Reporting – HEDIS, HealthShares
• Hospital Quality Collaborations for a decade
– OB Collaborative
– Maryland Indicators
– JCAHO measures
– AHRQ measures HQIP Program
– IHI 100,000 Lives
– E-Tip Program
• Increased from 14 hospitals in 2003 to a projected 56 by
year–end 2006
The goals of HQIP are:
• Improve the quality of care our members receive
– Accelerate performance improvement activities
– Identify opportunities that represent shared priorities for Plan and hospital
• Identify and share best practices
• Use quality performance incentives to support and recognize
hospitals’ active participation in data driven, outcome oriented
performance improvement processes.
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4. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA HQIP
Transition to Incentive Approach
• Collaboration only gets you so far
• Payments raise the level of interest on hospital
side, help drive competition
• Determined 1% to 2% would get attention of
leadership
• Payments range from $35,000 to $2.6 million
• Total 2005 payout estimate: $9.1 million
BCBSMA HQIP
Challenges of Incentives
• Changed the nature of relationship
• Required connection between finance / contracting
and quality
– Health Plan side
– Hospital side
• Reconciliation of contracting and quality
schedules
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5. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA HQIP
Other Program Components
• Hospital Quality Forum
• Direct QI consultation
• Hospital Quality Newsletter
• Email and Telephonic Connections and Interactions
• Role of the Plan:
– Provide comparable results
– Foster collaboration
– Help hospital QI staff do more of what they want to do anyway
BCBSMA HQIP
Cohort Identification
• Academic
• Small – <5000 Discharges Annually
• Medium – 5000-10,000 Discharges Annually
• Large -- >10,000 Discharges Annually
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6. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA HQIP
Benefits and Challenges of External Data
Benefits:
• All payer
• Single source
• Independent entity prioritizing and producing measures
Challenges
• Reliance on three external parties to get results
– Hospitals, State and Vendor
• Use of data for payments can lead to delays
BCBSMA Hospital Quality Improvement Program
HQIP Process
Cross-functional
group determines
Annual Report
measurement set Get Commitments from the hospital
from Hospitals
Design
Reports Work Starts for
Improvement Forum,
Produce Reports,
Newsletters,
meet with contacts
Calls, Emails
4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q
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7. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA Hospital Quality Improvement Program
2004-2005 Bridge Measurement Set
• Pneumococcal Screening and Vaccination
• CHF Discharge Instructions
• Others
– CAP – Antibiotic Timing
– Medication Reconciliation
– CHF – LVF Assessed
– AMI – Aspirin and Beta Blockers on Admission
BCBSMA Hospital Quality Improvement Program
2005 AHRQ Measurement Set
Inpatient Quality Indicators:
• Mortality following AMI, Mortality following congestive heart failure,
In hospital mortality following acute stroke, In hospital mortality
following pneumonia, Mortality following CABG (ICD-9)
Patient Safety Indicators:
• Selected infections due to medical care, Death in low mortality
DRG’s, Postoperative respiratory failure, Failure to rescue,
Postoperative pulmonary embolism or deep vein thrombosis, OB
trauma – vaginal with instrument (for hospitals delivering
obstetrical care), OB Trauma – vaginal without instrument, Birth
Trauma - injury to neonate
Measures of Access to Primary Care/Care in the Community:
• Pediatric Asthma, Diabetes – Short Term Complications
Advisory Measures
• JCAHO, CPOE
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8. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA HQIP
Results
2003
• 71% (10/14)achieved goal
2004
• 77% ( 33/43) achieved goal
HQIP Improvement
MP ending 6/30/2005
Summary
•34 hospitals met all goals, will be paid incentive increases
•One hospital met one of two goals, will be paid half
•Six hospitals did not meet goals, will not be paid
•One hospital appealing the decision
Pneumococcal Screening and CHF Discharge Instructions
Vaccination
60 60
54
50 50 49
40 40
30 30 30
24
20 20
Baseline Intervention Baseline Intervention
•25 hospitals representing 18 systems •4 hospitals representing 4 systems
•Average improvement: 30 percentage •Average improvement: 19 percentage
points points
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9. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
BCBSMA Hospital Quality Improvement Program
Next steps:
2006 and beyond:
• Considering model to incent performance across defined set
of AHRQ measures
• Expansion of model to include components for:
– Member experience
– Board reporting
– Public Reporting
– Leapfrog Fourth Leap
– NSQIP
BCBSMA HQIP
Lessons Learned
• Evolve relationship
• Be prepared for challenges when tied to financial
payment
• Focus on partnership and long-term objectives
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10. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement
Hospital Quality
Improvement Program
BCBSMA Presentation to IHI
December 13, 2005
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