Hospital Quality Program

We are working with hospitals to provide better care for patients. Our Hospital Quality Program (HQP) is designed to evaluate performance using nationally-recognized quality measures to track and improve patient care.

The design of the refreshed program addresses four areas of hospital performance:

  • Hospital leadership's commitment to quality
  • Improvement of health outcomes
  • Lowering the cost of care
  • Improving patients' experience

The program is an example of our desire to work in new ways with our network of providers. It also shows our commitment to improving the health care delivery system in North Carolina and the quality of hospital care available to our members.

What's different about the refreshed HQP?

The Hospital Quality Program (HQP) is our next generation quality improvement program, helping acute care hospitals improve care outcomes. The HQP program will measure hospital performance using a standard set of quality measures, while collaborating with the hospital community.

What is Different?

The refreshed Hospital Quality Program aims to improve outcomes for our customers by:

  • Using a standard set of nationally-recognized quality measures to promote improvements in care
  • Making the measurement of hospital performance more focused, structured and transparent
  • Sharing hospital performance data (e.g. readmission analysis) with individual hospitals
  • Promoting collaboration and knowledge sharing among hospitals
  • Aligning reimbursement with quality improvement

HQP Design

The goal of our Hospital Quality Program is to improve care outcomes for our customers, and promote transparency of performance among acute care hospitals.

Improvement in care outcomes has a direct impact on patient safety, care-quality and cost. For example, hospitals can reduce their costs and save more patients' lives by:

  • Reducing the hospital-acquired infection rates
  • Ending elective deliveries before 39 weeks
  • Reducing readmission rates

Our Hospital Quality Program is designed to align with the Institute for Healthcare Improvement's "Triple Aim" initiative. The latter seeks to improve health system performance in three areas:

  • Patient experience (including quality and satisfaction)
  • Health outcomes
  • Reducing the cost of care

While designing the refreshed HQP we were guided by the following principles:

  • Use quality measures that are tied to value and accepted as the industry standard
  • Motivate hospitals to improve care quality by tying reimbursement to performance
  • Collaborate with the hospital community to design and administer the program
  • Minimize the administrative burden on hospitals
  • Keep the program operations simple and transparent

During the program design phase, we were guided by a Hospital Quality Advisory Group comprising select hospital chief medical officers and hospital executives from Quality and Medical Affairs departments. We also received input and cooperation from the NC Quality Center and various individual North Carolina hospitals.

Quality Measures

In the refreshed HQP, hospital performance will be evaluated and scored in these four categories:

  • Hospital Leadership Commitment to Quality
  • Improved Health Outcomes
  • Lower Cost of Care
  • Better Patient Experience

The following table identifies the specific quality measures to be evaluated and scored under each category. Refer to the HQP Policy Manual and HQP Measurement and Evaluation Methodology for additional details:



HQP Quality Measurement and Evaluation

The goal of measuring and scoring hospital quality is to help hospitals improve care quality. This is done by examining performance and sharing insights with the hospital.

Refer to the HQP Policy Manual and HQP Measurement and Evaluation Methodology for additional details.

Contact:

For additional information please contact us at (919) 765-1871 or your Network Management representative.