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"A Quiet Revolution" by Andrew Dreyfus

There has been much focus in the health care reform debate on who pays for care – essentially, what is the optimal balance between government, employers, and individuals. But so far, we have paid little attention to how we pay for care.

Recent actions by state and federal government may shift the conversation. Medicare just announced that it will no longer pay for treatment of certain preventable hospital errors, injuries and infections. On October 1, MassHealth will launch a $74 million pay for performance program targeting health disparities and encouraging improvement in several specific areas of care. The state’s Group Insurance Commission is already using payment to reward cost-effective care.

These moves are part of a quiet revolution in health care, a movement toward using the payment system to influence the quality, safety, and effectiveness of care. As Lisa McGiffert, Consumers Union policy analyst, told the New York Times: “Medicare is using its clout to improve care and keep its patients safe.”

At Blue Cross, we are already seeing how changing the payment structure can support quality and safety improvements.

Since 2003, we have developed and expanded incentive plans for hospitals that link higher quality to higher payments.

It’s remarkable what participating hospitals have achieved. Last year,12 hospitals reduced their rate of specific post-operative complications by 48 percent. Another six hospitals achieved an overall 37 percent reduction in acute myocardial infarction after surgery. Other hospitals saw reductions in obstetrical complications, pressure ulcers, wound infection, and mortality.

Our incentive plans for 2008 are even more ambitious. They support participation in programs like IHI’s 5 Million Lives campaign and the American College of Surgeons’ National Surgical Quality Improvement Program, and integrate measures of health outcomes, patient experience, and involvement of hospital leadership in improving quality and safety.

So, I welcome John McDonough’s question about what insurers are doing. John, I think you’ll find we’re doing quite a bit, although we can and will do more. We welcome MassHealth and Medicare to the payment-change effort. The more payers that are committed to paying for quality rather than quantity, the more we support hospitals and doctors in providing exceptional care.Andrew Dreyfus is Executive Vice President for Health Care Services at Blue Cross Blue Shield of Massachusetts and former President of the Blue Cross Blue Shield of Massachusetts Foundation.

This program aired on August 22, 2007. The audio for this program is not available.

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