Fifteen Hawaiian hospitals are teaming up with the Hawaiian Medical Service Association—a Blue Cross Blue Shield independent licensee—to build a statewide value-based purchasing program tied to quality metrics and patient outcomes developed by the Premier health care alliance. The program, Advanced Hospital Care, which organizers claim marks the first value-based purchasing collaborative in the United States linking a statewide collection of hospitals with a private payer, would ultimately tie 15 percent of hospital and physician payment from HMSA to quality and outcome measures.

In the first year alone, the program aims to have quality-based reimbursement comprise 5 to 7 percent of all payments to health care providers, Hilton Raethel, senior vice president of HMSA, said at a recent press conference. Raethel said previous pay-for-quality initiatives in Hawaii had borne inconsistent results, but he is confident the new program will succeed.

"We could have taken a couple of years to develop our own program, but Premier has metrics which have been tested and demonstrated to improve quality," Raethel said.

Advanced Hospital Care also will work in tandem with the Centers for Medicare & Medicaid Services to help reach patient safety targets developed by Health & Human Services through its new Partnership for Patients, including goals to reduce preventable errors in hospitals by 40 percent and preventable complications by 20 percent. In addition, the program will work with hospitals to avoid impending reductions in Medicare payments with high rates of readmissions and health care-acquired infections, provisions of the Affordable Care Act that will take effect over the next two years.

Melinda Ashton, M.D., medical director for patient safety and quality services at Hawaii Pacific Health, a four-hospital system with locations throughout the state, says access to a large set of quality and patient metrics via Premier is an improvement over previous pay-for-quality efforts in Hawaii, which typically have ended up comparing a relatively small group of hospitals.

"We really only have 10 large hospitals that get compared," Ashton says. "If there are very small differences among us, and we get rated, that ends up with winners and losers that probably are inappropriate. I think expanding the field of comparison is going to be advantageous to all of us."

Steve Robertson, chief information officer for Hawaii Pacific Health, adds that access to real-time quality data was also a draw for the new program. Previously, HMSA relied on claims data that was sometimes as much as 18 months old to measure hospital performance, he says.

"In the past, we've essentially had to take HMSA's word for it with regard to what our quality performance was based on claims data," Robertson says. "Because those results were so far removed from the actual practice, it's really difficult to have the conversations you really need to have to improve care and align the incentives. By getting more real-time data, you can create those incentives.