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Highmark's Hospital Pay-for-Performance Program Demonstrates Impressive Results

Model Program Saves Money and Improves Quality of Health Care

PITTSBURGH, Oct. 11 /PRNewswire/ -- During the past year, Highmark has worked with select hospitals in Western Pennsylvania as part of its pay-for- performance program called QualityBLUE to significantly reduce central line- associated bloodstream infections.

Central lines are used to monitor patient status and deliver medication and nutrition to critically ill patients through vessels that lead directly to the heart. Bacteria introduced through these lines can lead to life- threatening infections. The national average, is five infections per 1,000 line days for intensive care unit patients. The average hospital-wide rate for hospitals in the QualityBLUE program was only 1.5 per 1,000 line days.

While there were 214 such infections at QualityBLUE hospitals in the past year, had they occurred at the national average rate, there would have been a potential of 1,115 infections. At an estimated cost of $36,000 per case, that represents a potential savings to the health care system of more than $32 million.

"There are numerous areas which participating hospitals and Highmark focus, but this specific measure really shows the progress the program is making," said Michael Madden, M.D., medical director of medical performance management programs for Highmark. "These hospitals are safer for patients, and there is a significant cost savings. The QualityBLUE program is really making a difference when it comes to quality care for our members."

The Highmark QualityBLUE hospital pay-for-performance program began in fiscal year 2002 with six hospitals. Today, 29 hospitals participate in the program in Western Pennsylvania, and the program was recently expanded and now includes one hospital in Central Pennsylvania, with further expansion projected. Since the inception of the program, the number of hospital QualityBLUE participants has grown to encompass more than 60 percent of Highmark's inpatient/outpatient hospital claims in the Western region.

QualityBLUE also focuses on the prevention, reduction and/or elimination of Methicillin Resistant Staphylococcus Aureus (MRSA). Hospital participants in QualityBLUE screen patients when they are admitted to high-risk areas, such as the intensive care unit. During the past year, 8.4 percent of patients were identified as carriers of MRSA. When a patient is found to be a carrier of MRSA or infected with it, hospitals implement precautions to prevent the spread of the bacteria to others, reducing hospital-acquired infections. Some of those precautions include isolating the patient, using only dedicated equipment, strict adherence to appropriate hand hygiene and wearing protective clothing such as gowns and gloves.

"By implementing these specific measures to deal with MRSA, participating hospitals have made it safer for patients and reduced the spread of this difficult-to-treat infection," said Madden.

"We applaud Highmark in their efforts to provide positive incentives to help improve the quality of healthcare," said John Jernigan, M.D., Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.

"Their results suggest that patients can benefit when insurance carriers work with hospitals to improve care through a strategy of positive reinforcement."

Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.6 million people through the company's health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit

SOURCE Highmark Inc.
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