Hospital quality program

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) views quality as one of the foundational elements in the transformation from a pay for volume to a pay for value healthcare system. To provide customers with the highest value for their hospital care (i.e. best care outcomes at an optimal cost), Blue Cross NC works with acute-care hospitals and health systems on the Hospital Quality Incentive Program (HQIP).

HQIP is Blue Cross NC's Pay-for-Performance program for acute care hospitals. Hospitals can earn a reimbursement increase if they meet quality and performance targets.

HQIP was inspired by the Institute for Healthcare Improvement's "Triple Aim" initiative to improve health system performance in three areas: Patient experience (including quality and satisfaction), Health outcomes and reducing the cost of care.

HQIP's design and administration is guided by 5 key principles:

1. Optimize the value of hospital care for the patient (customer)
2. Align hospital reimbursement to achieving performance targets
3. Use industry standard quality measures endorsed by national organizations
4. Minimize the administrative burden on hospitals and keep the program simple and transparent
5. Share information with hospitals to assist in improving outcomes.

HQIP includes performance measures in 3 categories: Patient Safety & Health Outcomes, Patient Satisfaction, and Cost of Care. HQIP quality measures, performance targets and other components are updated on an annual basis.

The following identifies the specific quality measures to be evaluated and scored under each category.

• Mortality Outcome Measures (Small/Rural facilities only)
  • Pneumonia
  • Acute Myocardial Infarction
  • Heart Failure
  • Stroke
• Obstetrics Outcome Measures
  • Elective Delivery Prior to 39 Weeks Rate
• Patient Safety Measures
  • CLABSI Rate
  • CAUTI Rate
  • SSI for Abdominal Hysterectomy Rate
  • SSI for Colon Surgery Rate
  • C. Diff
  • MRSA
  • PSI 90

• All Cause 30-Day Unplanned Readmission Rate 

HCAHPS Measures

• Patients who reported that staff "Always" explained about medicines before giving it to them
• Patients who reported that yes, they were given information about what to do during their recovery at home
• Patients who "Strongly Agree" they understood their care when they left the hospital
• Percent of patients rating hospital 9 or 10

• For HQIP eligibility and participation, contact your Provider Network representative.
• For HQIP operations such as quality measures, scope, performance targets, data reporting, results computation and technical details, contact Chris Marion, Program Manager at 919-765-3151 or email Chris.Marion@bcbsnc.com
• If you have clinical questions or would like to offer a suggestion, contact Vivek Nanda, MD at 919-765-7218 or email Vivek.Nanda@bcbsnc.com