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With a strong focus on improving health outcomes, managing health care costs and ensuring the best possible experience for its customers, Capital BlueCross places a high priority on helping health care providers improve quality of care.

As a component of its Hospital Pay-for-Value Program, Capital BlueCross uses inpatient discharge data purchased from the Pennsylvania Health Care Cost Containment Council (PHC4), for 15 participating hospitals. The company combines this data with Agency for Healthcare Research and Quality (AHRQ) tools to evaluate Patient Safety Indicators, and then uses these indicators to assess the incidence of adverse events and in-hospital complications, and sets goals for improvement.

“If a hospital organization meets established thresholds, they will receive a pay-for-value reward,” said Kara Fox, Capital BlueCross Manager, Medical Value. “Value is the quality of the outcome per dollar spent.”

Fox said that while there are many different health care quality measurements available, using Patient Safety Indicators based on PHC4 data is one method for Capital BlueCross to evaluate the quality of inpatient care.

Dave Resek, MBA, PMP, Senior Quality Improvement Analyst Lead at Capital BlueCross, receives the data from PHC4 and uses it along with the AHRQ Quality Indicators software to calculate Patient Safety Indicators.

“The PHC4 Inpatient Discharge Data is of high quality and easy to use,” said Resek. “I have found the data field values to have a validity rate in excess of 99.95%. The ability to receive data for multiple institutions in a common format speeds processing and analysis. And since the data is payer-independent, we get a more global view of an institution’s performance than if we analyzed our own plan’s data alone.”

In addition to engaging hospitals in quality improvement through the Pay-for-Value Program, Capital BlueCross is bringing hospitals and health systems together through a new collaborative developed in partnership with the Health Care Improvement Foundation (HCIF). A first-of-its-kind for the central Pennsylvania and Lehigh Valley regions, the collaborative is zeroing in on one important health initiative at a time. The first area of focus that the collaborative’s health care system participants have agreed to work on with Capital BlueCross and HCIF is palliative care.

“One of the most important goals of this partnership is to foster collaborative relationships among participating organizations,” said Fox. “Through engagement and collaboration, our hospitals, providers and communities will benefit from high-performing health care delivery systems demonstrating enhanced levels of safety, quality and effectiveness.”

The collaboration uses diverse program elements – such as workgroups, webinars, events, web-based resources, regional meetings, site visits and regular data collection and measurement – to help organizations and their affiliated providers build the improvement capacity within and across their organizations to address quality improvement issues.

“Bringing organizations together to talk about quality encourages them to share with one another with the common goal of improving the health care experience of patients,” said Fox. “Everyone learns from one another, and that is incredibly valuable.”

For more than 75 years, Capital BlueCross has served residents and businesses in central Pennsylvania and the Lehigh Valley. Delivering value through innovation and collaboration, Capital BlueCross continues to evolve, investing in products, services and partnerships to create an even healthier future for customers with more choice, greater convenience and enhanced quality of care. Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association. More information about Capital BlueCross can be found at

The Health Care Improvement Foundation is an independent nonprofit organization that leads health care initiatives aimed at improving the safety, outcomes, and care experiences of all patients with the hopes of facilitating the development of a high-performing health care delivery system demonstrating enhanced measures of safety, quality, and effectiveness. More information about the HCIF can be found at

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