Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Hospital Performance Incentive Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Excellus BlueCross BlueShield Parent organization Lifetime Healthcare Companies Primary program contact information Name Carrie Whitcher Title Director, Performance Improvement Organization Excellus Blue Cross Blue Shield Email Carrie.Whitcher@Excellus.Com Phone (716) 857-4534 Sponsoring organization type Health Plan(s) Multiple health plans Source of funding associated with program set-up costs Funding source Other Percent contributed by sponsor and grant organization Program set-up costs 0 Source of funding associated with program operations costs Funding source Other Percent contributed by sponsor and by grant organization Program operations cost 0 Start date & end date of the program Start Date 1/1/2005 End ongoing   PROGRAM SCOPE Geographic scope of program New York Individuals affected by program as a percentage of total population, if known Employer/commercial health plan- active workers Employer/commercial health plan- dependents Employer/commercial health plan- retirees Medicaid Medicare Coverage of affected individuals (for purchaser sponsors only) HMO HMO/POS PPO Indemnity Plan product(s) the program applies to (for plan sponsors only) HMO HMO/POS PPO Indemnity Direct target(s) of your program's incentives/rewards Hospital type General Hospital unit Individual, System Consumers- health plan enrollees (for health plan respondents only) HMO HMO/POS PPO Indemnity Medicare Medicaid Recruitment of program targets Mandatory- all members of target group that meet certain criteria Specify Patient/enrollee volume; Length of existing contract PROGRAM PERFORMANCE MEASURES Clinical/Safety Performance Inpatient clinical and safety measures included in your program Measure sources AHRQ Quality Indicators CMS/Premier Hospital Quality Incentive Demonstration Hospital Quality Alliance JCAHO Core Measures Other NQF Measures Specify Safe Practices IHI 5 Million Lives Campaign Other Specify Patient surveys, such as CAHPS, Other surveys Measure areas Cardiac Acute myocardial infarction (AMI) Congestive heart failure (CHF) Coronary artery bypass graft (CABG) surgery Percutaneous coronary interventions (PCI) Orthopedics Hip replacement Knee replacement Pulmonary Community-acquired pneumonia (CAP) Safety Adverse drug event rate NQF's 27 hospital safe practices (Leapfrog) Evidence-based hospital referral (Leapfrog) ICU staffing (e.g., intensivists) (Leapfrog) Prophylactic antibiotic use pre-surgery Surgical infection rate Measurement areas Cardiac Coronary artery disease (CAD) Pulmonary Community-acquired pneumonia (CAP) Safety Adverse drug event prevention Appropriate antibiotic prescribing for infections Other measurement areas Diabetes Health information technology adoption measures Adoption of inpatient HIT Barcoding Clinical documentation CPOE Decision support (e.g., alerts, reminders or point-of-care guidelines) E-prescribing Adoption of outpatient HIT E-prescribing Decision support (e.g., alerts, reminders or point-of-care guidelines) Patient-Centeredness Patient-centeredness measures Facility CAHPS Other Specify Press Ganey, Picker, Jackson Organization Resource Utilization and Cost Resource utilization Average length of stay (ALOS) Emergency room (ER) visits Pharmaceutical usage- generic usage rate Re-admission rates Health plan performance measures Performance measure weighting Clinical performance % or N/A 30-70 Safety % or N/A 0-50 HIT adoption % or N/A 0-30 Patient-centeredness (i.e. HCAHPS) % or N/A 0-50 Resource utilization % or N/A 0-50 Data Reliability Sources of data Existing or new data Existing data sources Data type Medical record data Self-reported Data extracting entity Independent entity Data aggregator/analyzer Program sponsor Ensures data accuracy Yes Means of ensuring accuracy Auditing Specify who audits and how often Health Plan and annually Risk-adjustment mechanisms used None of the above INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date 1/1/05 End Date ongoing Structure of the incentive or reward Direct financial reward- increased payment Differential reimbursement for providers; (e.g., increase in rate of reimbursement) Specify add-on to inpatient commercial reimbursement rate Scoring used to determine payment Absolute goals- patient level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Absolute goals- population level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Incremental goals - improvement over previous reporting period Pay for improvement of one measure/group of measures Pay for improvement of each measure Frequency of reward or penalty Annually Time lag between measurement and receiving reward/penalty One - three months Total dollar amounts awarded during the most recent calendar year $7.9 million Source of financial payments for meeting performance goals Current budget redistributed COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program operations Receives compensation for administrative burden of data collection No Characteristics of post-implementation target feedback Incentive target given opportunity for full explanation of results before use Incentive target groups/individuals given comparative information Information provided on how results will be used Mechanism to consider additional information and communicate back to target Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Confidential Frequency of performance feedback to the targets Annually PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Other types of evaluation Specify dollars saved, days avoided Evaluator Program sponsor Additional results of program evaluation For the first time in late 2006, we have been able to perform a comparative analysis, comprising an early small sample, of the program effort put forth by at-risk vs. not-at-risk hospitals, and specifically how their performance compares. We calculated the percent change in the improvement for the 10-measure starter set as a whole (not by measure) from 2004 to 2005 for the 12 at-risk hospitals vs. 59 not-at-risk hospitals in the Excellus network. For the 12 At-risk hospitals, compliance with the 10 measure starter set improved 7.6%. For the 59 not-at-risk hospitals, compliance with the 10 measure starter set improved 3.3%. While we are not claiming that this difference in performance is due solely to this program, we are paying close attention as to how we can track its effect. It’s anticipated that as our program evolves and captures more performance data, we will be able to continue to quantify the value of this program to hospitals, employers, and consumers. Note: This Analysis Compared 12 At-Risk Hospitals to 59 Not-At-Risk Hospitals (At-Risk for the Specific Condition). The Analysis omitted data from (1) Top 10% Hospitals for each measure, and (2) Hospitals who reported less than 25 patients for an individual measure. Lessons learned from designing and implementing the program We have begun to move more toward composite measurement in light of hospitals who have small sample sizes and as we look to impact care in all of AMI, Heart Failure, Pneumonia, and SCIP measures. We have recognized the value in communicating blinded results and lessons learned with our hospitals who are participating in the program through an annual quality forum that we sponsor.

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