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Programs need to not only prevent infections but also eliminate them.
THERE'S NO DOUBT healthcare-acquired infections (HAIs) have significant impact in terms of healthcare spending and human suffering. Quantifying the impact and ensuring a reduction in incidents is a bit more difficult.
"We wanted a program that was rigorous, relevant and responsive to national norms," Weiland says.
When the program was started in 2001, Weiland recalls skepticism on the part of hospital administrators-which is common when a payer introduces an outcomes-based program.
"The quality team generally met with the CFO, the sensitivity being that [providers might view the program] as a 'gotcha' of some sort," Weiland says.
With infection metrics, Highmark estimates that 351 cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) were avoided during the past four years, resulting in up to $12.2 million in savings. In addition, up to 384 lives and $45 million were saved by avoiding an estimated 1,535 central-line-associated bloodstream infection cases.
Weiland says that Highmark isn't resting on its laurels. The program is updated with new conditions and benchmarks yearly. The current focus is on developing sustainability so that there is no erosion of quality as programs mature.