In what organizers are billing as a first-of-its-kind experiment, a network of Hawaiian hospitals are teaming up with the Hawaiian Medical Service Association—a Blue Cross and Blue Shield licensee—to build a statewide value-based purchasing program. The program, dubbed Advanced Hospital Care, is believed to be the first time a private payer and hospitals have collaborated statewide on a value-based purchasing program around quality metrics and patient outcomes. The program would ultimately tie 15 percent of hospital and physician reimbursement from HMSA to quality and outcome measures developed by the Premier health care alliance.

In the first year alone, the program aims to have quality-based reimbursement comprise 5-7 percent of all payments. Fifteen hospitals will participate at first, Hilton Raethel, senior vice president of HMSA, said recently. Raethel said previous attempts at quality-based reimbursement between HMSA and Hawaii hospitals had shown inconsistent results, but he is confident that the new program, which uses metrics developed by hospitals via Premier's national network, would 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.

Recently, I caught up with two leaders of Hawaii Pacific Health—a four-hospital system that is the largest health care employer in Hawaii—Melinda Ashton, M.D., medical director for patient safety and quality services, and Steve Robertson, CIO. Ashton and Robertson echoed Raethel's hopes the partnership would reap greater dividends than previous pay-for-quality arrangements—this time, by using more timely quality and performance metrics. Before, they said, HMSA had relied on claims data that were sometimes as much as 18 months old to measure hospital performance.

"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 said. "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 the data more real time, through the actual event, you can create those incentives."

Robertson and Ashton also noted that Advance Hospital Care is designed to dovetail with value-based purchasing programs administered by Medicare through the ACA. And that's where my interest in this effort comes in—in the wake of national reform, many health care executives and thought leaders have argued that meaningful changes to care delivery will ultimately emerge from voluntary collaborations in the field, and not simply in response to federal mandates and regulations. Hawaii is one of the smallest states in the union, which may make it a good test case for this kind of field-based implementation.

"We've got a really tight community of relationships here in Hawaii, and the hospital systems have really all come together and supported each other," Robertson pointed out. "If it weren't for the readiness of hospital CEOs, it wouldn't have happened."