How Can a Company Like Elevance Health Help Improve Patient Safety in Hospitals?

Despite these efforts to improve quality over nearly two decades, a recent study found adverse events in nearly one of every four admissions, and approximately one-fourth of those events were considered preventable. Both the Centers for Medicare and Medicaid Services (CMS) as well as the Centers for Disease Control and Prevention (CDC) reported that hospital quality and safety metrics have declined since the onset of the COVID-19 pandemic. Because patient safety is integral to quality of care, there are significant opportunities for more effective integration of patient safety into both value-based care measurement as well as implementation.
 

What are the challenges to adding patient safety measures into VBC contracts?

Dr. Eugene Hsu, chief medical officer, Medicare clinical operations, Elevance Health: There are two tactical obstacles.

First, quality measures employed in VBC contracting often require the ability to distinguish care providers based on sufficient volume and variability. For example, the National Quality Forum’s “serious reportable events” represent less than 1% of all adverse events. Other adverse event measures require either close surveillance or voluntary reporting and often vary in the quality of reporting. 

Second, care providers have an inherent conflict of interest when provider-reported data are used as the basis for their payment. For example, under fee-for-service contracts, reducing adverse events could potentially lead to a decrease in hospitals’ profit margins. To foster alignment of financial incentives, a more effective approach would be to incorporate patient safety measures into VBC contracts that allow care providers to share in the savings resulting from improvements in patient safety and potentially even support care providers that don’t meet benchmarks, rather than merely penalizing them for errors.

What are the strategies payers can use to integrate patient safety measures into VBC contracts?

Winn: There are two keys to success when it comes to integrating patient safety measures; first, there must be a sustained and productive collaboration between payers and care providers, and second a commitment from all stakeholders in healthcare system.
 

How does the Elevance Health Quality-In-Sights: Hospital Incentive Program (Q-HIP) work?

Hsu: The voluntary program is a long-standing collaboration with acute care hospitals. Patient safety measures make up 80% of the overall score, with the remainder mostly focused on patient experience. Each participating hospital receives its own scorecard annually, with results broken out by measure so hospitals understand how they perform compared to all U.S. hospitals that participate. Under this pay-for-performance program, hospitals can earn a bonus if they achieve predefined quality targets. Elevance Health-affiliated plans under Q-HIP do not penalize participating hospitals. For hospitals that may fall short of national benchmarks, they may still be able to earn points by improving year over year performance.

The Q-HIP program suggests that a sustained and productive collaboration between payers and care providers offers potential for integrating patient safety measures into VBC models to drive clinical improvements and financial efficiencies, but it requires commitment from all stakeholders in the health care ecosystem.

Do programs like these create administrative burden for hospitals?

Sai Ma, staff vice president, clinical quality, Elevance Health: We believe administrative burdens can be overcome a few ways--for example, by harmonizing measures and combining data across multiple payers, such as by using nationally agreed-upon standard measures. There can also be tighter integration of the standards with local measures and workflows by hospitals themselves.

Additional innovations can be considered in partnership with hospitals. These include:

• Introducing newer measures such as those suggested in the President’s Council of Advisors on Science and Technology (PCAST) report on patient safety.
• Leveraging advances in artificial intelligence to further reduce the administrative cost of surveillance and measurement of local hospital-acquired harms.
• Identifying opportunities both for primary prevention as well as secondary prevention after a safety event has occurred and intensive outpatient care management, particularly for populations experiencing health disparities.
• We believe it is the ultimate responsibility of hospitals, supported by payers that value patient safety, to incorporate a foundational safety performance dashboard and fully use it to improve hospital safety and quality while advancing health equity.

*VBC ties the amount that care providers earn for their services with the results they deliver for their patients, such as the quality, safety, equity, and cost of care. Through financial incentives, value-based care programs aim to hold care providers more accountable for improving patient outcomes.