In an effort to improve the quality, safety and efficiency of healthcare received by its members, Blue Cross & Blue Shield of Rhode Island (BCBSRI) recently collaborated with local network hospitals to create and implement the Hospital Quality Program. The program, which uses standard, "evidence-based" performance metrics, also realigns financial incentives so that hospitals that provide high-quality patient care receive more compensation. Fully 90 percent of the hospitals in the BCBSRI network have agreed to participate in the program this year, with BCBSRI striving for 100 percent participation by the end of 2012.
"A lot of Rhode Islanders aren't aware that there can be differences in the quality of healthcare received for the same medical condition," said Dr. Gus Manocchia, BCBSRI's senior vice president and chief medical officer. "According to the Centers for Medicare & Medicaid Services (CMS), for instance, one of our state's hospitals scored 99 percent for the treatment of heart failure last year, which is much better than the national average of 93 percent, while other local hospitals did not fare as well. BCBSRI commends Rhode Island hospitals for their willingness to increase transparency and share this type of quality data with the public."
Manocchia went on to explain that the Hospital Quality Program works by benchmarking patient care against national hospital quality standards provided by the CMS and Hospital Care Quality Information from the Consumer Perspective (HCAHPS). Hospital "Discharge Best Practice" Measures—which were created by Quality Partners of Rhode Island, the Rhode Island Quality Institute, local hospitals and local physicians in collaboration with RI's health plans—are also a key element of the program. Collectively, these hospital metrics measure treatment quality around specific conditions such as pneumonia and heart disease, improve the likelihood of a safe and effective discharge after a hospital stay, and assess patient perceptions regarding their healthcare experience.
"Very few of my colleagues around the country share this type of detailed data with health insurance companies," said Mary Reich Cooper, M.D., J.D., senior vice president and chief quality officer of Lifespan Corporation. "But we've been partnering with BCBSRI for a number of years now and find that taking a more collaborative approach to improving care across the state is good for our patients' health."
In fact, Lifespan hospitals, including Miriam Hospital, Newport Hospital and Rhode Island Hospital during 2010, either met or exceeded both local and national quality standards on a number of key measures, including heart failure, pneumonia and surgical care improvement.
"We're not perfect—yet," laughed Cooper. "One or two of our hospitals could do a better job of keeping noise levels down around patients' rooms at night, for instance. But we're exceedingly proud of the high quality of care patients receive at our facilities, and we're committed to doing even better."
In addition to helping improve the overall quality of local hospital care, BCBSRI's Hospital Quality Program also helps moderate long-term healthcare costs by improving patient health and reducing hospital readmissions. Under the terms of the program, base hospital reimbursement increases are aligned with inflation, with additional financial incentives available to hospitals that successfully meet the agreed-upon quality scores.
"Ironically, healthcare is one of the few industries today where financial incentives are linked to the volume of services provided, not the quality of those services," explained Manocchia. "If you own a restaurant and you serve food that tastes bad, you're going to lose customers. If you're a car manufacturer and your car doesn't perform well in crash tests, you're going to lose customers. But the United States spends more per capita on healthcare than most other developed nations, and we aren't any healthier."
Rhode Islanders interested in learning more about local hospital quality are encouraged to visit www.hospitalcompare.hhs.gov. According to Manocchia, BCBSRI is also making this public data available on BCBSRI.com.
Manocchia concludes: "We'll continue to collaborate with our hospital partners here in Rhode Island to improve quality of care, but it's important that consumers of healthcare also understand that they have a critical role to play. I encourage every member evaluating options to review the hospital quality data available on our website so that they can make more informed decisions for themselves and their families."
Blue Cross & Blue Shield of Rhode Island is the state's leading health insurer and covers more than 600,000 members. The company is an independent licensee of the Blue Cross and Blue Shield Association. For more information, visit BCBSRI.com and follow us on Twitter @BCBSRI.