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Highmark's Collaboration With Hospitals and Doctors Continues to Yield Benefits for all Patients
Date:11/3/2010

PITTSBURGH, Nov. 3, 2010 /PRNewswire/ -- Whether it's reducing infections for patients, increasing the number of generic drugs to reduce costs or collaborating with hospitals to develop a philosophy and culture of quality, Highmark's QualityBLUE pay-for-performance (P4P) programs continue to evolve to help save lives and health care dollars.

The company's most recent internal report on the hospital and physician P4P program demonstrates a number of positive results.

One of the most successful methods found to reduce health care costs is to increase the rate of clinically appropriate generic drug use substitution. Since 2006, when the measure was implemented, the percent of generic medications prescribed has increased from an average of 46 percent to 73 percent. Using the average Highmark prices for generic and brand medications and calculating what would have been paid if QualityBLUE participating physician practices prescribed brand drugs, it can be estimated that more than $87 million was saved during the past year through increased generic substitution.

In addition to savings incurred through generic substitution, patients also pay lower copayments for generic drugs. These copayments have remained steady during the past five years while copayments for other brand drugs have increased. Highmark's average retail generic price is $14 less than the national average.

"One focus of the physician and hospital programs is clinical quality", said Linda Weiland, Highmark's vice president of provider performance and information management. "We work collaboratively with health care providers to ensure patients receive evidence-based care in accordance with nationally established guidelines."

The QualityBLUE hospital P4P program was started in 2002 with six hospitals and has expanded to 63 hospitals participating in the program today. About two-thirds of all primary care physicians in Highmark's physician network participate in the QualityBLUE Primary Care Physician program.

A number of positive results were also revealed regarding hospital participation with the program.

A central line is an invasive catheter device inserted in a patient and used to monitor the circulating blood through the body, provide nourishment and administer medication. While these catheters are life sustaining, they introduce the risk of infections for patients.

QualityBLUE hospitals have been monitoring hospital-wide central line infections (CLAB) for four consecutive years and when compared to the Centers for Disease Control National Healthcare Safety Network (CDC-NHSN), the QualityBLUE CLAB rates have been consistently lower than the national hospital-wide rate.

A comparison during the four years demonstrates that QualityBLUE hospitals prevented 1,283 central line associated bloodstream infections, saving 154-321 lives and produced in $9.4 million to $37.4 million in patient care cost savings ($7,288 to $29,156 per CLAB.)

MRSA is an antibiotic resistant organism that can potentially cause life-threatening bloodstream and surgical site infections in hospital and community settings. QualityBLUE hospitals search for and identify MRSA-positive patients via nose cultures upon admission and discharge to hospital. Hospitals implement infection  prevention procedures to limit patient-to-patient spread. Through this program, 318 infections were averted with a potential cost savings of between $8.6 million and $11 million.

"The QualityBLUE program has been a powerful catalyst for needed change in health care facilities in Pennsylvania," said Michael Doering, executive director of the Pennsylvania Patient Safety Authority. "The positive results remind us that improvements can be made given appropriate attention by inspired health care professionals."

"This program has helped improve care for all patients, not just Highmark members because of the changes physicians and hospitals have made in patient care delivery," said Weiland. "With the backdrop of health care reform, this program will continue to be important because of the national emphasis on patient safety, value driven care delivery and the pursuit of sustained high quality for all consumers."

In October The Blue Cross and Blue Shield Association (BCBSA), in collaboration with the Harvard Medical School Department of Health Care Policy, recognized Highmark with a Best of Blue Clinical Distinction Award for QualityBLUE, its hospital pay-for-performance program. Harvard researchers evaluated and selected programs by Blue Cross and Blue Shield plans for recognition based on their innovation, effectiveness and potential for replication.

About 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 4.7 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 www.highmark.com.


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SOURCE Highmark Inc.
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