IHI BCBSMA Hospital QI Presentation

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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

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IHI BCBSMA Hospital QI Presentation

  1. 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 1
  2. 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. 2
  3. 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. 3
  4. 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 4
  5. 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 5
  6. 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 6
  7. 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 7
  8. 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 8
  9. 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 9
  10. 10. A11/B11: The Role of Health Plans in Hospital-based Quality Improvement Hospital Quality Improvement Program BCBSMA Presentation to IHI December 13, 2005 10

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