Skip to main content

The Building Blocks of Hospital Quality in North Carolina

By Blue Cross NC | May 22, 2014 | Healthy Lifestyle, Industry Perspectives

Feature Blog Image

If you’ve been following our blog, you’ll have noticed that collaboration is at the heart of what we do here at BCBSNC—it’s one of our core principles. But collaboration extends far beyond what we do in the workplace; it greatly inspires what we do in the community and industry. One of those prime examples is our continuing focus on hospital quality in North Carolina.

Improving care in hospitals for our customers makes a big difference. It means better health outcomes, improved patient experience, and reduced health care costs. That’s why we’re working with the hospital community to evaluate hospital performance and reward facilities that are committed to improving the quality of care through a new Hospital Quality Program. Using a standard of nationally-recognized quality measurements, these efforts make quality part of their contract to improve the care available to our customers all across North Carolina.

Improving Quality of Care Saves Lives and Money

Hospital quality has far-reaching impacts that go beyond what you might expect. Through this program hospitals show their commitment to better health care by reducing preventable situations including hospital-acquired infection rates, elective deliveries prior to 39 weeks, and readmission rates. This commitment to quality not only improves your health but also reduces overall health care costs.

In the book Demand Better! Revive Our Broken Health Care System by Sanjaya Kumar, chief medical officer at Quantros, and David B. Nashin it was reported that, on average, patients receive the recommended care only 55% of time. They explain:

How well physicians did for any particular condition varied substantially, ranging from about 79 percent of recommended care delivered for early-stage cataracts to about 11 percent of recommended care for alcohol dependence. Physicians prescribe the recommended medication about 69 percent of the time, follow appropriate lab-testing recommendations about 62 percent of the time and follow appropriate surgical guidelines 57 percent of the time. Physicians adhere to recommended care guidelines 23 percent of the time for hip fracture, 25 percent of the time for atrial fibrillation, 39 percent for community-acquired pneumonia, 41 percent for urinary-tract infection and 45 percent for diabetes mellitus.

Those statistics are both shocking and unacceptable from where we stand.

Through our Hospital Quality Program, we work closely with hospitals to implement a framework that ties reimbursement to value. Participating hospitals are evaluated in four categories:

  • hospital leadership’s commitment to quality
  • improved health outcomes
  • improved patient experience
  • lower costs

“Quality of care must be a unified effort, doctors, hospitals and insurers all working toward a better health care system that benefits the patient,” says BCBSNC’s Dr. Patti Forest. “Blue Cross has several programs focused on quality care, the Hospital Quality Program is one example of how we are finding new ways to work with our network of providers for customers.”

In addition to the Hospital Quality Program, BCBSNC works with community-based doctors in the Blue Quality Physician Program (BQPP) for commitment to patient-centered care. Our goal is to be part of the solution in addressing health care cost and quality challenges right here in North Carolina.