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Highmark's hospital quality program continues to reduce costs and readmission and improves lives for members

Highmark Inc.

PITTSBURGH (Feb. 4, 2016) — Highmark members are benefitting from the insurer's long-time quality program to improve outcomes at hospitals. The most recent data is from the calendar year 2014 and shows continued success with reducing various health care-associated infections (HAIs) and reducing readmissions to hospitals.

The program's focus includes tracking the following infection categories:

  • Catheter-associated urinary tract infections (CAUTI)
  • Clostridium difficile infections (CDI)
  • Central line-associated blood stream infections (CLABSI)
  • Surgical site infections (SSI)

The Quality Blue program documented nearly 1,000 potential averted infections just in 2014. During the past nine years that HAIs have been tracked by Highmark, the program has potentially averted about 6,600 infections saving potentially between $41 million and $128 million in averted costs.

Most importantly, for the nine year journey — approximately 267 to 555 lives were saved as a result of potential adverted central line-associated blood stream infections (CLABSI).

"We're very pleased to continue to partner with our network hospitals to strive to reduce the number of health care associated infections. We have very measureable and tangible outcomes, which is very significant for our members and group customers. They recognize the value of it," said Amy Fahrenkopf, M.D., vice president and medical director at Highmark Inc. "We know that other Blue Plans nationally have seen the results and have asked us for counsel many times over the years as they develop similar programs in their own markets."

"PinnacleHealth appreciates the positive effect collaborations such as this can have on increasing the community's focus on quality and how hospitals improve health outcomes," says Michael A. Young, PinnacleHealth president and CEO. "Our strict processes and procedures have helped us achieve some of the lowest infection and readmission rates in the state, and we are pleased to work with organizations such as Highmark to further our efforts so that we can continue to reduce infections and provide the safest care to our patients."

2014 Results


For 2014, readmission rates were evaluated. For Medicare Advantage populations the 30-day readmissions decreased by 3.1 percent.

Additionally, 14 hospitals have consecutively reported on 30-day readmissions for the Quality Blue Hospital Program since July 2010. The readmission rate for those 14 hospitals decreased by 9 percent from July 2010 through December 2014; resulting in more than 2,200 averted readmissions and a cost savings of nearly $22 million.

Palliative Care

Highmark supports a patient's right to choose their end-of-life care experience and has taken a leadership position by incorporating a focus on palliative care in the Quality Blue Hospital Program. Participating hospitals in 2014 were required to demonstrate an increase in palliative care consultations for complex patients with life limiting conditions through a team approach using shared decision making, collaboration among providers and improved communication with the patient and their family.

Palliative care provided in the outpatient setting has been found to be less costly than traditional clinical or inpatient care. There was a 33 percent increase in the number of palliative care consults during 2014.


The program continues to focus on reducing the number of first time, uncomplicated Cesarean deliveries. Reduction in the number of births by Cesarean section results in faster recovery times and less risk for both mother and baby by reducing or eliminating complications and infections associated with surgical procedures.

For 2014, the number of primary uncomplicated Cesarean deliveries continued to decline, potentially averting 241 Cesarean sections and the associated risk for complications for both mother and baby.

The hospital program, which began in 2002, today includes 119 hospitals from Pennsylvania, West Virginia and Delaware.

About Highmark Inc.

Highmark Inc. is among the ten largest health insurers in the United States and is the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.3 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit
For more information, contact:
Leilyn Perri
Highmark Health