BlueCross/Blue Shield of Illinois (BCBSIL) recently announced a new data sharing arrangement with the DuPage Medical Group, a large independently owned physician medical group in the Chicago area. This arrangement calls for BCBSIL to share its medical claims and (unnamed) quality data with physicians of the DuPage Medical Group. These data will help the physicians better understand the healthcare services their patients are receiving outside the DuPage clinic walls, including the quantity and quality of care their patients are receiving from non-DuPage physicians.
This information is becoming more important to physicians as their reimbursement for services provided is increasingly tied to patient outcomes. The Blues organization also announced their goal of having 75% of their Illinois market to be paid on the basis of improved quality and lower costs within the next 5 years. This trend has been driven by the Center for Medicare and Medicaid Services (CMS), with HHS Secretary Burwell announcing the 2018 CMS target of 50% of payments based on value, and 95% of fee for service payments having a quality component as part of the payment.
We are likely to see many other arrangements similar to the BCBSI deal in the commercial market over the coming months and years. The country is gradually realizing that fee for service payment arrangements become an incentive to provide more care, while value based payment models incent higher quality care.
Rewarding higher quality care and penalizing poorer quality care is a step in the right direction, and for certain elements of care, quality can be readily measured. For example, for most common surgical procedures, standards have been developed to measure complications, length of stay, hospital-induced infections, mortality and other discrete endpoints. It may not be as straightforward to measure quality of care in the primary care settings, but quality can be measured.
An interesting article published in 2012 in The New England Journal of Medicine offered a framework for measuring system-related quality of care. The authors suggested 6 domains of quality that could be measured:
- Patient safety
- Patient and caregiver-centered experiences and outcomes
- Care coordination
- Clinical care
- Population and community health
- Efficiency and cost reduction
This framework may be well suited to measure the effectiveness and quality of care being delivered in the primary care setting, and these efforts need to be supported. Hopefully this BCBSIL and DuPage Medical Group partnership will spur other large carriers to try similar arrangements with hospitals and physicians. Combining cost metrics with quality metrics can deliver the type of transparency that is lacking in today’s fee for service world. The payer community has been asking for this type of transparency, and consumers are now asking for the same information.
I’m hopeful the metrics agreed upon will be shared publicly. It will be interesting to follow this new arrangement over time to see if the quality metrics are robust, and if patient care actually improves.
Michael L. Taylor, MD, FACP
Chief Medical Officer
Once again, the selection of St. David’s HealthCare and Hill Country Memorial as 2014 Malcolm T. Baldrige award winners and performance on the 100 Top Hospitals® National Balanced Scorecard overlap. Hill Country Memorial and five of the six hospitals in the St. David’s HealthCare system are or have been 100 Top Hospitals winners. This is important because a significant statistical association between use of Baldrige best management practices and highly balanced performance excellence, as measured by the 100 Top Hospitals National Balanced Scorecard, was found in . At that time, only 21 hospitals had been named Baldrige Award recipients since its initiation in 1991. These new dual winners add to the growing list of dual winners announced by the Malcolm T. Baldrige program in 2013 (see listing below). This is all very good news for measurement of the impact of leadership in hard data.
The identification of a growing overlap between use of known best management practices (Malcolm T. Baldrige program) and objective measurement of leadership impact on an organization (100 Top Hospitals program) is a testament to the enormous potential of the emerging science of management. Unlike efforts to measure clinical and financial practice in healthcare, the objective research on measurement of leadership effectiveness is miniscule. There are good reasons for that. Very much like the now 30-year old effort to develop evidence-based medicine, complete success is elusive. Both the practice of medicine and the practice of effective leadership have a heavy component of “art” that defies quantification. Almost all of the thousands of management books published are experiential or philosophic – not empirical. Jim Collins’ books on chief executive officer characteristics and practices are among the very few evidence-based business books ever published. That is what makes the increasing number of Baldrige award winners who are also 100 Top Hospitals winners so heartening! There is the potential of an increasingly strong link between actual practice and empirical measurement.
To be explicit, , which is based solely on a balanced scorecard analysis of public data:
- Hill Country Memorial is a four-time 100 Top Hospitals winner (2014, 2013, 2012, 2003) in the very difficult category of Small Community Hospitals.
- St. David’s Medical Center, Austin (which includes St. David’s Heart Hospital and St. David’s Georgetown) is a five time 100 Top Hospitals winner (2014, 2013, 2012, 2011, 2010) and is in the Large Community Class.
- St. David’s Heart Hospital, a part of St. David’s Medical Center, is a 2015 and 2013 50 Top Cardiovascular Hospital winner.
- St. David’s North Austin Medical Center is a three time 100 Top Hospitals winner (2014, 2013, 2012) also in the Large Community Class.
- St. David’s Round Rock is a 2012 100 Top Hospitals award winner in the Medium Community Class which is the most difficult class to be selected a winner.
- St. David’s South Austin Hospital was a 2001 award winner and also is in the Medium Community Class and a 2005 and 2004 50 Top Cardiovascular Hospital award winner.
In 2013, the Malcolm T. Baldrige program issued a listing of Baldrige and state or sector based state and sector program award winners who had also won the 100 Top Hospitals award.
Baldrige Award Recipients
- Advocate Good Samaritan (Downers Grove, IL) a 2010 Baldrige Award recipient
- North Mississippi Health Services North Mississippi Medical Center (Tupelo, MS) a 2012 Baldrige Award recipient
- Poudre Valley Hospital (Fort Collins, CO) a 2008 Baldrige Award recipient
- Regional Medical Center at Plano (Plano, TX) a 2011 Baldrige Award recipient
- Sutter Davis Hospital (Davis, CA) a 2013 Baldrige Award recipient
Baldrige-based State or Sector program awards
- Advocate Good Samaritan Hospital (Downers Grove, IL), 2010 Illinois Performance Excellence recipient, 2010 Baldrige Award recipient
- Advocate Lutheran General Hospital (Park Ridge, IL), 2012 Illinois Performance Excellence winner
- Banner Boswell Medical Center (Sun City, AZ) – parent Banner Health, 2012 Showcase in Excellence Award (AZ) winner
- Duke University Hospital (Durham, NC), 2013 Governor’s Award of Performance Excellence in Healthcare recipient (NC)
- INOVA Fair Oaks Hospital (Fairfax, VA), 2006 U.S. Senate Productivity and Quality Award (VA) winner
- Kettering Medical Center (Kettering, OH) – parent Kettering Health Network, 2010 Governor’s Award for Excellence (OH) winner
- Maury Regional Medical Center (Columbia, TN), 2009 Excellence Award (TN) winner
- McKee Medical Center (Loveland, CO), 2006 Timberline Award Recipient (CO)
- Riverside Methodist Hospital (Columbus, OH), 2005 Achievement of Excellence (OH) winner
- Sauk Prairie Memorial Hospital and Clinics (Prairie du Sac, WI), 2012 Wisconsin Forward Award winner
- SSM St. Joseph Hospital West Lake (Saint Louis, MO) – parent SSM Health Care, 2011 Missouri Quality Award recipient, 2002 Baldrige Award recipient
- St. David’s Medical Center and St. David's North Austin Medical Center (Austin, TX) – parent St. David’s Healthcare System, 2008 Texas Award for Performance Excellence winner
- St. Luke’s Hospital (Cedar Rapids, IA), 2010 Iowa Recognition for Performance Excellence winner
- Sutter Davis Hospital (Davis, CA), 2012 Governor’s Award for Performance Excellence (CA)
- Texas Health Presbyterian Hospital Rockwall (Rockwall, TX) – parent Texas Health Resources, 2013 Texas Award for Performance Excellence recipient
- University of Colorado Hospital (Aurora, CO) – part of a joint operating agreement with Poudre Valley Health System, 2010 Rocky Mountain Performance Excellence recipient, 2008 Baldrige Award recipient
Senior Vice President, Performance Improvement and 100 Top Hospitals