Pay for Quality Improvement
Improving Patient Safety, Patient Outcomes and Provider Clinical Effectiveness
The California Health Care Coalition is a nonprofit membership
organization of 44 employers, trust funds and unions representing over
three million California plan beneficiaries. Our “Pay for Quality
Improvement” (PQI) program is unique in California. It brings local
customers together with major providers to improve the safety, quality
and cost of California health care services.
CHCC’s PQI Program originated in Modesto, where a CHCC committee of
local employers and unions, the UFCW National Health & Welfare Trust
Fund, senior Doctors Medical Center (DMC) administrative, physician and
nursing representatives and senior Tenet Health representatives
established an agreement to jointly review performance, set specific
improvement goals and establish a PQI fund to increase payment to DMC
when it meets jointly set improvement targets.
Based on the program’s success, CHCC is currently in discussion with
Tenet Health about extending the Modesto pilot to Tenet hospitals in
California. CHCC has also approached other hospitals and systems about
establishing PQI programs and is working with Blue Shield to implement a
Central Valley and San Diego PQI program with the following components:
Joint performance reviews with data subject to independent third
party verification and reviewed by qualified medical professionals
retained by CHCC. Performance reviews are based on data that
providers currently collect and report to state and federal
agencies; Joint establishment of specific and measurable improvement goals
based on standards developed by the California Hospital Assessment
and Reporting Task Force (CHART), the Centers for Medicare and
Medicaid Services, the Joint Commission for the Accreditation of
Health Care Organizations (JCAHCO) and the National Quality Forum.
Improvement goals include clinical processes and patient outcomes,
as measured by mortality rates, hospital-associated infections rates
and Never Events; Establishment of a Pay for Quality Improvement Fund to support
meaningful improvements in provider clinical effectiveness and
patient outcomes; Increased use of PQI providers through CHCC member education and
joint communication strategies to increase use of PQI providers.
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