After a decade of documenting, Highmark, one of the nation's largest Blue Cross and Blue Shield affiliates, says physicians and hospitals in its Quality BLUEpay-for-performance initiatives consistently outperform providers who are not part of the program.
In its annual report for fiscal 2011, Highmark says Quality BLUE has used financial incentives to lower healthcare-acquired infection rates—saving hundreds of lives and tens of millions of dollars—and improve screening rates and overall patient safety. The quality measures continue to improve even as the program has grown to include 1.7 million Highmark members, 81 hospitals, and 1,600 practices in 49 counties in central and western Pennsylvania.
Deb Donovan, director of provider performance and strategy at Pittsburgh-based Highmark, told HealthLeaders Media that the secret to the PFP model is simple.
"Frankly, it is skin in the game," Donovan says. "The hospitals place a portion of their contracted reimbursement at risk on performance in the program, and there is enough money at risk for the organization that it gains the C-suite's attention. It quickly galvanizes the organization around aligned goals and helps drive clinical improvements."
Donovan points to several key metrics in 2011 for both hospital and physician PFP programs: