Image of SBH Health System, a number 1 hospital for HealthFirst medicaid patients

SBH Health System has been an active participant in the HealthFirst Quality Incentive Program (HQIP) program since it began in 2012, and has demonstrated continued improvement in its performance.

That level of performance reached its pinnacle in 2016, when SBH recently received a 4-star rating and was ranked as the #1 hospital for HealthFirst Medicaid patients, and among the top five hospitals for HealthFirst Medicare, when compared with all participating hospitals. This includes such large academic medical centers such as New York – Presbyterian, Montefiore, and the Mount Sinai Health System.

SBH reached a collective score of 4.0 out of 5.0 for the 33 measures focused on access, preventive care, acute and chronic disease management, medication adherence and patient satisfaction, and achieved a 4 or 5 star rating on 21 other measures. In meeting these metrics, as well as showing significant improvement on 11 additional measures compared to 2015 performance levels, SBH not only continued to demonstrate a commitment to high-quality care, but also earned over $4.5 million in incentive payments related to the program for the year.

The HQIP program measures the quality of care provided to patients in HealthFirst Medicaid and Medicare-managed care programs, and covers roughly 30,000 patients who have been assigned to SBH-associated physicians and practices across the South/Central Bronx. Patients receive care across a variety of clinical service lines, including internal medicine, pediatrics, family medicine, dental, ob/gyn, and behavioral health departments, and the program utilizes standardized metrics that allow for comparison across the 40 HealthFirst-member hospitals and serves as a barometer of the care provided to patients within the program.

Through use of national standards as defined by both the National Committee on Quality Assurance (NCQA) and the New York State Department of Health Quality Assurance Reporting Requirements (QARR), care is measured across multiple domains, including timeliness of access, patient satisfaction, quality of clinical care, and ER and inpatient utilization. Special emphasis is placed on measures within the well-known Healthcare Effectiveness Data and Information Set (HEDIS) tool, which covers specific metrics related to screening and disease prevention; comprehensive care for chronic disease such as diabetes, hypertension, and asthma; medication adherence for chronic disease; and behavioral health care services for depression and other mental health issues.

“Accomplishments of this magnitude are unattainable without a strong, committed and accountable team,” says Dr. Raj Gurunathan, director, Division of General Internal Medicine, Department of Medicine. “SBH has been successful in assembling a winning interdisciplinary team of physicians, nurses, patient care navigators, managers and front line staff, who have developed and implemented sustainable workflows and processes to support compliance with the measures.”

Added Irene Borgen, vice president, Ambulatory Care Innovation and Transformation, “Through numerous efforts aimed at patient outreach and engagement; improvements in decision support for clinical providers through use of the EMR; and the leveraging of information technology resources, many in the SBH community have contributed to this incredible achievement and in accomplishing these results, and we look forward to 2017 and beyond with much anticipation.”