Health insurers among leaders in using outcome measures

Health insurers at the forefront of using outcomes-based quality measures include such organizations as Blue Cross and Blue Shield of Louisiana and HealthPartners.

At the Louisiana Blues, a focus on outcome measures is a major component of its overall quality improvement strategy. The Baton Rouge-based payer is always looking for ways to harness measures that reflect how a patient’s health status is affected by healthcare services.

Its Quality Blue Primary Care program, launched in 2013, is designed to help the state’s primary-care doctors better care for and manage their patients with chronic conditions like diabetes, heart disease and high blood pressure.

A big part of the program’s success rests on the use of quality measures, particularly those focused on outcomes. The Louisiana Blues tracks things like patients’ potentially avoidable emergency room visits, medication adherence or hemoglobin A1C levels.

Under the program, the insurer’s nurses compile the data and speak every week with the 701 primary-care doctors in the program to highlight patients who need follow-up care based on the data available. The program includes about 300,000 patients across the state.

“The data we are providing fills in gaps (about the patient population), said Dr. Vindell Washington, chief medical officer at the insurer.

Since the quality program began, the percentage of enrolled members meeting quality goals has risen each year, and there’s been a $27 reduction in per-member/ per month costs on average for the 300,000 patients in the program, according to the insurer.

Washington said when the Louisiana Blues forms programs like this, its executives are thoughtful about which measures are used and particular attention is given to those focused on outcomes. The payer wants the data to be valuable to providers for the patient populations they treat.

“We have more measures than we know what to do with,” he said. “We are trying to get better and better at measuring the ultimate outcomes so institutions can deliver the best care.”

Years of use

HealthPartners, an integrated system based in Bloomington, Minn., has “been focusing on outcome measures for several years,” said Dr. Andrew Zinkel, associate medical director for quality.

For example, HealthPartners tracks patients that haven’t had important screenings or tests and then shares that information with those that are part of its health system.

Research shows healthcare consumers respond better to messages from their provider rather than their health plan, so HealthPartners physicians send letters to patients’ homes asking them to book an appointment for a diabetic myopathy screening or diabetic eye exam.

“We are able to identify those people easier on the health plan side,” Zinkel said.

“I think most health plans are in agreement that outcomes measures are where we should be,” Zinkel said. “It provides better value to the patients, and improves population health better than just knowing if a process is done.”