Value, 2005

Blue Cross and Blue Shield of Illinois

August 2005

Blue Cross and Blue Shield of Illinois (BCBS-IL) incorporates many of the AHRQ Inpatient Quality Indicators and Patient Safety Indicators into its reporting of hospital-specific quality data. This effort is the beginning of a pay-for-performance program for hospitals that is intended to improve patient outcomes and control health care costs.

The first BCBS-IL Hospital Profile was sent to hospitals in 2003. It reported selected indicators based on the AHRQ Quality Indicators, using all-payer data. The Second Annual Profile, sent to hospitals in 2004, reported selected Inpatient Quality Indicators and Patient Safety Indicators.

Since all-payer data is not currently available for Illinois, the AHRQ indicators for the Second Annual Profile were reported using the best available alternative, a database combining Medicare Provider Analysis and Review and BCBS-IL data that includes more than 70 percent of Illinois hospital admissions. The Medicare database contains charge data and clinical characteristics, such as diagnoses and procedures, for every hospital inpatient bill submitted to CMS for payment.

In addition to the AHRQ indicators, the BCBS-IL Hospital Profile for urban hospitals includes Leapfrog public reporting and compliance with Leapfrog standards, member and physician survey scores, structural indicators, utilization efficiency, and administrative efficiency. For rural hospitals, some indicators are not reported. A point system was developed so that the profile for each hospital is summarized by an overall score. For the AHRQ indicators, points are based on a comparison to results for other hospitals within the same peer group.

In April 2003 and October 2004, BCBS-IL mailed the Hospital Profile to CEOs of the more than 150 contracted Illinois non-specialty hospitals. The 2004 profiles were sent to 93 urban and 63 rural hospitals.

There was wide variation in performance. For some hospitals, the profile provided hospital leaders with positive feedback. For hospitals with lower scores, however, the profiles identified potential opportunities for improvement.

Carol Wilhoit, MD, BCBS-IL medical director for quality improvement, says, "The profiles have, in general, been well-received and have opened the door to productive discussions with hospitals about quality and patient safety. An early outcome is a dramatic increase in the number of hospitals that publicly report to Leapfrog. Public reporting of some profile indicators began in March 2005."

Going forward, additional quality and safety-related indicators will be added to the profiles. The 2005 profiles will contain Leapfrog's new fourth leap and Hospital Quality Alliance indicator results. Furthermore, hospital contracts will increasingly incorporate pay-for-performance components related to the profile.

Impact Case Study Identifier: CDOM 05-03
AHRQ Product(s): Healthcare Cost & Utilization Project—Quality Indicators (HCUP-QI)
Topic(s): Patient Safety, Quality
Scope: Illinois

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