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Children's Hospital Colorado, Anthem Blue Cross and Blue Shield collaborate on value-based payment model

The new version of the program focuses on a number of key areas important to pediatric populations.

Jeff Lagasse, Associate Editor

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Children's Hospital Colorado and Anthem Blue Cross and Blue Shield have joined forces to create a new version of Anthem's Quality-In-Sights: Hospital Incentive Program, or Q-HIP, which is specifically focused on children's facilities contracted with Anthem.

Q-HIP is a value-based reimbursement program which Anthem introduced in 2003 -- participating hospitals are eligible to receive incentives based on clinical quality. The new program launched at Children's Colorado allows Q-HIP to expand outside of its traditional short-term, general acute-care facility footprint. Specifically, the pilot will tie a portion of Children's Colorado's future reimbursement increases at-risk on performance against the program scorecard.

The new version of the program focuses on a number of key areas important to pediatric populations, such as surgical site infection outcomes for specific procedures, including spinal fusions, neurological shunt placements and cardiothoracic procedures.

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Other areas of focus include implementing evidence-based clinical care guidelines for specific patient populations, such as those with asthma, bronchiolitis and sepsis; and imaging utilization in patients with confirmed appendicitis presenting through the emergency department.

"Historically, payers have applied adult metrics to pediatric facilities, which clearly could not be aligned with the most important healthcare initiatives and goals for kids around safety, clinical effectiveness, outcomes and patient experience," said Jena Hausmann, president and CEO of Children's Hospital Colorado. She said the new plan should ensure the best possible health outcomes.

Anthem expects the Q-HIP for Children's Facilities pilot to evolve as initial results are available through the collaboration with Children's Colorado. The insurer said it hopes to expand the model to children's facilities in other markets in the future.

Twitter: @JELagasse
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