News & Stories

Editor’s Note: This article originally ran on NJBiz.com on May 21, 2014.

Cooper tops all other N.J. hospitals in Horizon program

By Beth Fitzgerald

Horizon Blue Cross Blue Shield of New Jersey gives New Jersey hospitals a financial incentive — up to $250,000 per hospital — to encourage them to participate in the nationwide Leapfrog Group survey that rates hospitals on the safety and quality of the care they deliver.

This year, only one hospital earned the top award: Cooper University Health Care in Camden.

And while the program is only one of dozens that rank hospitals on numerous factors, the honor is significant. At least that’s how Cooper CEO John P. Sheridan, Jr., feels.

“Quality and patient safety are two of the most important measures in our health system,” he said. “This recognition shows we continue to put great emphasis on all of our programs from an increase in hand washing to what catheter products are used that create a safer environment for our patients.”

The program — which runs nationally — was launched in 2006 as a way to improve safety and quality of care in the industry. It appears to be working in New Jersey.

Horizon has seen participation grow from just a few hospitals to 51, or nearly all the hospitals in its network — and during this time, New Jersey hospitals have improved their overall Leapfrog scores, rising to seven among the states nationwide, from the mid-40s years ago.

Jim Albano, vice president of network management and healthcare innovations at Horizon, feels the company’s Hospital Recognition Program deserves some of the credit for the improvement.

“I do believe the Horizon program is very much aligned with what hospitals are trying to accomplish: which is to make sure that patients are safe and have a good experience when they have to go to a hospital,” he said.

Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association, said she’s not aware of any other New Jersey health insurer offering a program like Horizon’s.

“This is part of a growing trend of promoting — and rewarding — improved value in healthcare,” Kelly said. “Under health care redesign, the goal is to provide better care in the right setting at reduced costs.”

Hospitals are graded on a number of questions in a number of categories, including general information, maternity care, high-risk surgeries, hospital-acquired conditions and resources. They are given grades on a 1-4 scale: 1 (willing to report), 2 (some progress), 3 (substantial progress), 4 (fully meets standards).

A hospital gets the maximum $250,000 for scoring in the top 10 percent in the U.S. Hospitals outside of the top 10 percent can receive smaller awards.

Overall, more than 1,400 hospitals voluntarily participated nationwide. Horizon is now distributing a total of $3.6 million to hospitals for their performance on the 2013 Leapfrog survey.

A top 10 percent ranking is harder to earn each year, but Albano thinks that’s a good thing for everyone as Leapfrog provides an annual push for hospitals to do better.

“There is always room for improvement,” he said. “You never get perfect at any of this stuff because you’re caring for people. The raising of the bar is exactly what is required for hospital to keep focused on.”

And while Albano feels the Horizon program has played a role in the rising quality rankings of New Jersey hospitals, he is quick to point out that the company is just part of the process, adding the NJHA has been working on these issues for years, along with Medicare.

Albano said the push by Horizon to incentivize hospital quality benefits all the patients in the hospital — not just Horizon patients.

“We think providing a financial incentive is important because hospitals can take that money and put it back into their program,” he said. “It provides them a little bit of funding for improving processes and systems.”

Kelly agreed. She said hospitals, patients and payers benefit from efforts that improve quality.

“It shows that all stakeholders have a role to pay in reforming our healthcare system and making sure providers are able to deliver good care to their communities,” she said.