Anthem's P4P program wins Eisenberg award

Door to balloon times, complication rates slashed

Anthem Blue Cross and Blue Shield of Virginia, a subsidiary of WellPoint Inc., based in Richmond, has received a 2008 John M. Eisenberg Patient Safety and Quality Award for its development and implementation of performance-based reimbursement programs for Virginia hospitals, cardiologists, and cardiac surgeons.

These programs are known as the Quality-In-Sights: Hospital Incentive Program (Q-HIPSM) and Quality Physician Performance Program (Q-P3SM). Q-HIP and QP3 reward hospitals and physicians for practicing evidence-based medicine and implementing other nationally recognized best practices.

A quick look at the program's early results (it was launched in 2004) shows why the programs gained the attention of the award committee. Two cohorts were followed; in both, 75% percent of participants achieved the door-to-balloon time goal of 90 minutes or less, although their baseline rates were about 59% and 37%, respectively. Both cohorts also cut their rates of serious complications approximately in half.

Like many patient safety programs, this one got its impetus from the Institute of Medicine's landmark To Err is Human publication in 1998. "We had some hospital systems willing to be involved in this, and local chapters of the American College of Cardiology, so it started as a collaborative effort with various stakeholders," notes Robert Krebbs, program manager. There were 16 hospitals participating in the first year, he says, and today there are 69. "That's over 95% of inpatient facilities," says Krebbs, adding that the program is now "rolling over" into other WellPoint states.

Data collected regularly

Krebbs explains that on a quarterly and annual basis, participating hospitals send demographic information on their performance in "nationally endorsed, well recognized evidence-based" measures. These include, for example, The Joint Commission's National Patient Safety Goals, standards from the National Quality Forum, the IHI 5 Million Lives campaign, and CPOE. "We use a third-party organization (called the Patient Safety Organization) to collect and validate the data, and then we receive the scores back," he adds.

Krebbs says this use of a third party, trusted intermediary specializing in health care quality improvement and patient safety "provides an unbiased evaluation of Q-HIPSM submissions."

There is regular communication with the participating hospitals, he says. "We update the scorecard on an annual basis, and we share a copy with the hospitals," he says. "We have an annual meeting of all the hospitals to let them know what's coming up." In addition, he says, there is an external advisory panel with representatives from each hospital, and they also provide quarterly previews of what may be changing in the near future.

The financial rewards are set on a contractual basis, as a percentage "tacked on" adjustment to the facility's reimbursement rate. "We usually use 2% as an example on a hospital basis," says Krebbs.

Anthem's goal, he adds, is to achieve a common high level of care among all hospitals. "If you look at hospital quality as a bell curve, our goal is to tighten that curve," he says.

Public reporting begun

Effective November 2007, Anthem has made its hospital quality reports available on its web site, The Hospital Performance Reports focus on five health outcomes: cardiac care (cardiac catheterization and angioplasty); heart attack; heart failure; pneumonia; and surgical infection prevention. Visitors can view a detailed performance report for any Anthem-network hospital that participates in Q-HIP, or a side-by-side comparison of Q-HIP-participating hospitals in a specific region. Each Hospital Performance Report identifies where a hospital scored higher than the Virginia Q-HIP average.

[For additional information, contact:

Robert Krebbs, Program Manager, Anthem Blue Cross and Blue Shield of Virginia, Richmond, VA. Phone: (804) 354-7000.]