Highmark: Using EHRs To Drive Quality Improvement
August 4th, 2010
 by
Donald Fischer
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Donald Fischer of Highmark Blue Cross Blue Shield, Inc. (photo and bio above), is a participant in today’s National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Fischer’s presentation and supplements his discussion
At Highmark, we are constantly seeking new ways to work closely with our network providers to improve our members’ health, increase patient safety and reduce health care costs. We believe strongly that improved quality of care requires collaboration among members, providers, employers and health plans. Sharing of clinical and claims data with providers, and aligning financial incentives, are critical success factors in quality improvement and are closely linked to cost efficiency. With that in mind, we developed QualityBLUE more than 10 years ago, as a pay-for-performance program for primary care physicians, formalizing our efforts to improve quality of care and leading to more cost-efficient care.
Our focus has been to reduce the unwarranted variation in medical practice that cannot be explained solely by patient demographics or severity of illness. Unwarranted variation can be a sign of poor quality, and it comes in several varieties: It can be due to the underuse of tests and treatment known to be effective, the overuse of tests and treatments that may either not be evidenced-based or not have significant clinical value, or through the misuse of tests and treatments that contribute to medical errors. These types of errors are significant factors that are preventing us from assuring patient safety and the wise use of our financial resources. Highmark’s mutual goal with providers is to assure that the right care is provided to the right patient in the most appropriate setting and to reward providers when that goal is achieved.
QualityBLUE programs with different indicators have been set up for both hospitals and physicians. In the program for primary care physicians, there are six indicators that are measured to evaluate quality. These include clinical quality metrics appropriate to the given specialty, focusing on preventive tests like breast cancer screenings, well child visits and vaccinations. Other indicators include use of generic medications, evidence of a process improvement initiative and consumer-friendly hours of operation. Two additional indicators measure the adoption of electronic prescribing tools and adoption of electronic health records (EHR) that have met certification criteria.
We have placed a strong emphasis on EHR adoption because of the profound evidence that it improves patient safety and quality. But simply adopting these tools without changing processes in the practice setting is unlikely to be effective in improving quality. Computerizing chaos will not create order. For that reason, we have also focused on providing assistance so that practices can learn process improvement techniques and coaching them to succeed in the QualityBLUE program.
We recognize the challenge physicians face in acquiring health information technology and have taken the necessary steps to provide assistance to our network physicians. For instance, in 2008, Highmark contributed $29 million to help health care providers in our service area acquire electronic prescribing and EHR technology for their practices.
In addition, Highmark has joined with the Pittsburgh Regional Health Initiative, a nonprofit consortium focused on health care safety and quality improvements in southwestern Pennsylvania, to provide coaching support to primary care practices that are participating in the Centers for Medicare and Medicaid Services’ EHR Demonstration Project.
Highmark has also worked closely with the Pennsylvania Governor’s Office of Health Care Reform in its Learning Collaboratives for adoption of Patient Centered Medical Home in both Central and Western Pennsylvania. Using health information technology is integral to this ongoing effort.
The Adoption Of Meaningful Use Standards And The Way Forward
As an ardent proponent of health information technology, we welcome the adoption of meaningful use standards as a guiding structure to incentivize providers not only to adopt electronic health records, but to ensure that they use these tools to improve the quality of care that they deliver to their patients. Ideally, use of health information technology will transform care through access to full information at the point of care, use of decision support to assure better adherence to evidence-based guidelines and coordination of care among multiple caregivers. In so doing, we expect to see a reduction in unwarranted variation and improvement in patient safety.
It has been our intent to increase the relative weight of our indicators for EHR and e-prescribing adoption in our QualityBLUE program, and to move beyond adoption as the metric, to measure impact of adoption. Now that we have clear national standards for adoption and use of these tools, we have the guidance we needed to move forward. We are committed to raising the bar to provide further incentives for primary care physicians to move in this direction. We will be increasing the weight of these indicators and measuring use of the tools in alliance with the ONC’s meaningful use standards. Our QualityBLUE program will, thus, provide additional financial incentives to primary care physicians for all of our commercial membership and our Medicare Advantage membership. And why would we do this? Because we know that quality care is cost-efficient care. And the value that is created is worth it.
At this time, internists, family practitioners and pediatricians are eligible for this incentive program. We are now beginning to develop quality profiles for cardiologists in our network, and we will be including these EHR measures as indicators for them as well. We will next be profiling and providing incentives for other specialists, including obstetricians and gynecologists, practitioners who are not as likely to obtain benefit from CMS for EHR adoption. Going forward, Highmark will communicate, promote and incentivize the meaningful use standards among our network physicians in our Pennsylvania and West Virginia service areas.
In summary, we strongly support health information technology and the national efforts to advance EHR adoption. We welcome the new national standards for meaningful use, and know that physicians will appreciate the fact that goals for adoption will be aligned among both public and private payers. In our effort to decrease administrative burdens for providers, we must continue to focus on metrics that are standardized on a national basis. While we as health plans compete in many ways, we shouldn’t be competing on the development and use of quality metrics. These meaningful use standards represent a giant step forward, and aligning our incentive programs with these standards is the right thing to do.
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