Blue Cross Blue Shield of Massachusetts   2005 Annual Report

It's All About Quality Care

For centuries, the measurement of medical outcomes has been highly subjective. How can we develop objective quality measures that lead to improved care for all our members?

Since the days of Hippocrates, measuring and understanding the effect of health care for the patient has been as much art as science. Now is the time to develop measures for quality that rely on evidence-based medical practices and clinically proven results. At Blue Cross Blue Shield of Massachusetts, we are working with almost every hospital system in the state to implement objective, relevant, and accurate quality metrics.

In collaboration with some of the finest physicians in the world, we are adopting measures for quality, incorporating them into our contracts and linking incentive payments to these measures. Working together, we're adopting treatment guidelines that reflect evidence-based medicine. For example, we provide incentives so that patients with specific conditions, such as diabetes or congestive heart failure, get the best care as determined by clinical protocols. This helps patients to experience outcomes that are consistent with or better than nationally recognized standards.

We are committed to working with leading experts to develop and adopt evidence-based standards for care which ensure effective and safe medical treatment. Recently, the Massachusetts Department of Public Health and the Betsy Lehman Center for Patient Safety and Medical Error Reduction convened an expert panel—in which we participated—to develop evidence-based standards for bariatric surgery. These comprehensive standards, which our company has adopted, include recommendations for staffing, provider experience, patient selection, and education. We will collaborate with providers who conduct this complex surgery to put these recommendations in place so that patients achieve optimal outcomes.

Because we recognize that a robust technological infrastructure enhances quality, we provide incentives for organizations to implement Computerized Physician Order Entry systems and other technologies that provide clinical decision support. We're also engaged in innovative collaborations with several hospital systems to provide clinical decision support for radiology. Measuring quality and clinical outcomes helps to ensure that all patients receive best-practice health care.

These collaborative initiatives will yield:

• Higher-quality, safer care
• More efficient, affordable care
• Increased use of best-practice, evidence-based medicine

In addition, Blue Cross Blue Shield of Massachusetts participated in the Institute for Healthcare Improvement's 100,000 Lives Campaign. The Institute for Healthcare Improvement (IHI) is a Boston-based, not-for-profit organization dedicated to improving health care delivery throughout the world. As part of its efforts, the IHI launched a national campaign to encourage 2,000 hospitals across the country to adopt at least one practice proven to increase quality. We contributed $500,000 to support the campaign and awarded grants totaling $2.5 million to hospitals in Massachusetts that applied to us for funding and pledged matching funds. As a result of our commitment to quality and our collaboration with the IHI, every acute care hospital in Massachusetts received $35,000 and is implementing at least one proven initiative.

 

At Blue Cross Blue Shield of Massachusetts, we work each and every day to fulfill our promise, "To Always Put Our Members' Health First" This means exploring new ways to make sure that our members and the communities we serve all across Massachusetts get the most effective, safe, and efficient care possible. For us, when all is said and done, it's all about quality care.

 

Read further about our collaborative efforts…