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Improving health care quality and safety to create better outcomes and greater value for patients and communities can be a daunting challenge for leaders trying to transform our delivery system. In fact, the challenges are so large that it makes sense for key stakeholders of the health care system to work together to accelerate change. Many Blue Cross and Blue Shield (BCBS) health plans have partnered with hospital associations and hospitals to line up training, toolkits, data reporting and financial incentives to create a new health care delivery paradigm. Small, significant steps are moving us in the right direction under the guidance of hospital leaders and clinical champions.

The financial pressures are well documented in the popular press and annual reports of hospitals, insurance companies, government agencies and the checkbooks of the patients we serve. Annual spending on health care delivery is enormous and rising, representing $2.5 trillion that competes with many other social imperatives in our communities. Insurers, as well as hospital leaders, are alarmed by the constant upward trend in spending.

And the question remains, is the money being well spent? One study estimates that at least 30% of every dollar actually spent on care is funding ineffective or redundant care (Institute of Medicine, 2005). A recent report indicates that 84,000 premature deaths could be prevented if the US performed as well as some other nations (The Commonwealth Fund, 2011). Care is not only expensive, but sometimes actually harms the patient. One study suggests that $17 billion a year is spent on medical errors (Classen, et al., 2011). Our current approach to paying for services focuses on the volume or the number of procedures done to a patient, rather than on a successful outcome.

According to a recent Office of the Inspector General study based on a review of hospital charts, more than 13% of Medicare patients are injured or die from adverse events in medical treatment each year. This translates to 1 in 7 Medicare patients experiencing harm or death from a potentially preventable event (Levinson, 2010 OIG report).

There have been many campaigns and concerted efforts to improve quality and patient safety in individual hospitals, across states and nationally. Efforts to reduce central line associated bloodstream (CLABSI,) catheter-associated urinary tract infections (CAUTI) and other hospital-acquired conditions as well as use of quality and safety improvement tools, such as the surgical safety checklist, are beginning to have a significant and sustained impact in hospitals in several states, yet there is still work to be done. The Blue Cross and Blue Shield Association was a major funder of the Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign. Many organizations joined the campaign to learn and apply quality improvement techniques to every day practices. However, efforts are barely keeping up with the rising complexity of medical procedures and the acuity level of patients.
For more information or to check on your Center for Healthcare Governance order, please call 888-540-6111 or email