the challenge :: Consistently maintain the highest standard of care

Ultimately, the goal of health benefits is access to quality care. Yet, as the graph below shows, even patients with the best available coverage receive recommended care only about 55 percent of the time. The figure comes from a study that looked at a range of conditions where best practices have been identified through scientific research and clinical studies. It also found that 11 percent of the time patients received care that could be potentially harmful.

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Closing this gap is a real opportunity to save lives. A report by the National Committee for Quality Assurance found that 70,000 lives could be saved each year by providing appropriate care in just eight key areas, such as screening for certain types of cancer and controlling high blood pressure.

We can save health care resources. We can save lives. In a world of rapidly growing medical knowledge, physicians and other health professionals need timely access to information on best practices. But our health care system lacks commonly applied protocols of care, based on evidence from outcomes among a broad population.

Health care also lacks common processes for recording and transferring patient data seamlessly, with consistently high standards of privacy. Health care professionals need access to comprehensive patient data at the point of care—a key step in improving health care safety and quality. This will require systems for capturing patient data from hospitals, doctors’ offices, labs, pharmacies and other sources.

our part :: What WellPoint is doing to enhance health care quality

Collaborating to improve quality and safety. Anthem Blue Cross and Blue Shield has long been a leader in the health benefits industry in collaborating with hospitals on extensive quality programs. (Click here for more info.) And approximately 15,000 physicians in Anthem Blue Cross and Blue Shield networks receive a portion of their reimbursement for improving care to our members.

For example, hospitals selected for Anthem Blue Cross and Blue Shield’s Coronary Services Centers program in Indiana, Kentucky and Ohio must meet stringent clinical quality standards for patient care and outcomes for certain cardiac procedures. Since the program’s inception in Ohio more than 10 years ago, its hospitals in the state have seen a 38-percent decrease in mortality rates.

Another pioneer in pay-for-performance, Blue Cross of California paid $57 million in bonus payments to 134 medical groups in 2003 based on quality criteria. Blue Cross of California is also a member of a coalition of six health plans that awarded $50 million in bonus payments to 215 physician groups in 2004 based on clinical benchmarks.

These types of programs have been expanded to other WellPoint companies. In general, we provide incentives based on clinical measures that are widely accepted, improve with intervention, and are known to improve quality of life. These range from preventive screenings to treating chronic conditions such as asthma and high blood pressure. We also address quality from a consumer’s perspective by quantifying member satisfaction and customer service.

Anthem Blue Cross and Blue Shield was recognized by the Blue Cross Blue Shield Association in 2004 for developing medical policy in collaboration with physicians. Our medical policy model builds consensus with professionals on complex scientific issues. The first collaborative efforts included national scientific forums that helped shape our medical policy on bariatric surgery and bone marrow transplantation.

Supporting adoption of evidence-based care. A key benefit of the merger that created WellPoint, Inc. is the opportunity to use our national database and combined information technology resources to help make evidence-based medicine the standard of care for all.

We can aggregate statistics across our database while also protecting the privacy of each individual. Then medical professionals can use sophisticated analysis to determine the best course of treatment, based on the evidence of patient outcomes.