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Provider incentives, surgical checklists, centers of excellence among key efforts
Washington, DC — More than a decade since the Institute of Medicine's landmark To Err is Human report, patient safety remains a critical issue and imperative for the healthcare industry. In recognition of Patient Safety Awareness Week (March 4-10) led by the National Patient Safety Foundation, the Blue Cross and Blue Shield Association (BCBSA) is outlining 10 examples of key initiatives that Blue Cross and Blue Shield companies are undertaking to help improve patient safety at all levels of care.
"Patient Safety Awareness Week is an important reminder that hundreds of thousands of patients are being harmed while seeking treatment and much work remains to be done," said Allan Korn, M.D., BCBSA senior vice president and chief medical officer. "Patient safety is a top priority for The Blues® and it extends well beyond one week of the year. Blue Cross and Blue Shield companies work year-round with physicians and hospitals to create safer environments so that all patients receive safe, high-quality care. We acknowledge and honor that change comes only through the combined efforts of nurses and physicians at the bedside of patients. The Blues are committed to supporting their efforts in every way possible. To those who have already achieved some success, we salute you. To those looking for help in making further improvements, we stand prepared to help."
Following are examples of 10 patient safety initiatives that the Blues have undertaken:
System-Wide Reimbursement Policy
To encourage hospitals to adopt measures that eliminate medical errors, a Blue Cross and Blue Shield system-wide reimbursement policy prohibits reimbursement for preventable, serious events or medical errors. Additionally, members will not be charged for such incidences.
Patient Safety Toolkit
BCBSA has made available Toolkit resources designed to engage hospital leadership, eliminate infections and improve safety outcomes and includes the Blue Surgical Safety Checklist and the Central Line-Associated Blood Stream Infections (CLABSI) Checklists. The Blue Surgical Safety Checklist, adopted from the World Health Organization Surgical Checklist, consists of steps designed to improve communication and consistency of care within surgical teams. To help decrease blood stream related infections, which cause more than 30,000 deaths each year, the Toolkit includes CLABSI resources, which contain evidence-based guidelines for hospitals to implement.
Blue Distinction is a national designation program, developed in collaboration with the medical community to recognize those facilities that demonstrate expertise in delivering quality specialty care – safely, efficiently, and cost effectively. True to its original commitment as a quality-based program, Blue Distinction has evolved to become a value-based designation awarded to facilities that meet stringent quality measures, focused on patient safety and outcomes, developed with thoughtful input from the medical community, as well as cost measures that address consumers' need for affordable healthcare. Its goal is to help consumers find both quality and value for their specialty care needs, on a consistent basis, while encouraging healthcare professionals to improve the overall quality and delivery of care nationwide.
Technology Evaluation Center
BCBSA's Technology Evaluation Center (TEC) pioneered the development of scientific criteria for assessing medical technologies through comprehensive reviews of clinical evidence. TEC is one of only 14 Evidence-based Practice Centers for the federal Agency for Healthcare Research and Quality (AHRQ).
Preventing Readmissions through Effective Partnerships
Preventing Readmissions through Effective Partnerships (PREP) is a landmark quality collaborative between Blue Cross and Blue Shield of Illinois and the Illinois Hospital Association (IHA) to significantly reduce Illinois hospital readmissions by 2014 through redesigning hospital discharge processes. According to the Commonwealth Fund, Illinois ranks 44th in the nation with a 20.3 percent Medicare 30-day hospital readmission rate, well above the nationwide median. As part of this collaboration, more than 200 Illinois hospitals have pledged to reduce readmissions, with a goal of raising the state's performance from the bottom quartile to the second quartile nationally.
Collaborative Quality Initiatives
Through its series of Collaborative Quality Initiatives, Blue Cross Blue Shield of Michigan (BCBSM) and a group of Michigan hospitals have launched 12 statewide patient safety initiatives to address some of the most common and costly areas of surgical and medical care as one example of Blues efforts in this area.
Through data collection, BCBSM is assisting hospitals across the state to share and analyze information on patient risk factors, processes of care and outcomes of care. Hospitals can then design and implement changes to improve patient care outcomes. Initial and substantial improvements in angioplasty outcomes include a 180 percent increase in the patients with a door-to-treatment time of less than 90 minutes, a reduction in pre-operative IVC filter placement rate from 5.2 percent to 0.7 percent for patients undergoing gastric bypass and a nearly 10 percent reduction in mortality in general and vascular surgery.
Reducing Hospital-Acquired Infections (HAIs)
According to the Centers for Disease Control and Prevention, approximately 1 out of every 20 hospitalized patients will contract a HAI, and the annual direct medical cost of HAIs to U.S. hospitals ranges from $28.4 to $33.8 billion. Blue Cross and Blue Shield of Alabama is an example of the Blues addressing this head on. In 2010, more than 60 Alabama hospitals participating in the Alabama Hospital Quality Initiative saved more than 300 lives by preventing 1,520 HAIs in patients and avoiding more than 12,000 hospital days, saving $7.8 million in unnecessary costs.
Managing Pharmacy Benefits to Protect Patients
The Blue System is leading efforts to increase patient safety through proper handling and disposal of unused medication. BCBSA and Plans in 25 states supported and promoted the Drug Enforcement Agency's (DEA) National Drug Take-Back Day last year, which collected more than 375,000 pounds of medication.
Harnessing Technology to Drive Safety
Implementing electronic health records (EHRs) have proven to be successful for some primary care physicians when it comes to improvement in immunizations, blood pressure control, cholesterol control and preventive screening exams for patients. By way of example, through Blue Cross & Blue Shield of Rhode Island's Quality Counts program, the company partially funded physician practices' EHR adoption and provides bonus payments based on mutually agreed-upon quality measures. Family Medicine and Pediatrics experienced a 44 percent improvement and Women's Care experienced a 35 percent improvement.
Designing Incentive Programs to Ensure Safety
A Blues example of incentive programs is Highmark Blue Cross Blue Shield's QualityBLUE hospital pay-for-performance program which aligns reimbursement with high-quality care and improved outcomes for patients. Hospitals participating in QualityBLUE prevented 2,796 adverse events, saving at least 384 lives through initiatives to improve healthcare quality and safety.
"The work of the Blue Cross and Blue Shield companies across the country evidences the important commitment of a major payor to the patient safety work and reflects their understanding that it takes a collaborative team effort across all parties to deliver on the shared mission of making the healthcare system safer," said Diane Pinakiewicz, president of the National Patient Safety Foundation. "Patient Safety Awareness Week presents an opportunity to recognize the work that BCBSA and Blue Cross and Blue Shield companies are doing in this area and we congratulate them on their leadership and commitment.
For more information about how Blue Cross and Blue Shield companies are working to make healthcare work for every American, see the BCBSA report Building Tomorrow's Healthcare System .
About the National Patient Safety Foundation
The National Patient Safety Foundation (NPSF) has been pursuing one mission since its founding in 1997 — to improve the safety of care provided to patients. As a central voice for patient safety, NPSF is committed to a collaborative, multi-stakeholder approach in all that it does. NPSF is an independent, not-for-profit 501(c)(3) organization. Learn more about the work of the National Patient Safety Foundation and how you can get involved by visiting their website .
About the Blue Cross and Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 38 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 99 million members – one-in-three Americans. Find more information on the Blue Cross and Blue Shield Association and its member companies by visiting their website .