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Highmark makes change to hospital pay-for-performance program to place more emphasis on decreasing preventable readmissions

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Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania, West Virginia and Delaware through the company’s health care benefits business. To help improve member care, Highmark’s Quality Blue pay-for-performance hospital program now requires all participating hospitals to measure and reduce the number of hospital readmissions. Beginning this month, the program, which had previously allowed hospitals to choose any of the program indicators, will now require all participating hospitals to measure this important indicator in addition to their regular selections.

According to a recent Pennsylvania Health Care Cost Containment Council (PHC4) report, 185,190 of the approximately 1.5 million inpatient stays in 2010, or about 12.4 percent, fell into the potentially preventable classification.

Highmark’s Quality Blue program will require hospitals to focus on 30 day readmissions, identifying admissions within 30 days of a previous hospital stay providing an important overall measure of hospital quality. Readmissions can be caused by a number factors such as: poor discharge procedures, inadequate follow up care and medication related issues. Conditions that cause the most readmissions include heart failure and Chronic Obstructive Pulmonary Disease (COPD).

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