What large-scale programs really “move the needle” in hospital-based quality improvement? Punitive strategies, such as the Centers for Medicare & Medicaid Services (CMS)-sponsored “never events” approach, value-based purchasing or the Hospital-Acquired Condition Reduction Program, are unlikely candidates, and some would argue drive real problems underground. The more optimistic “pay for performance” strategies haven’t worked in the real world, as pointed out recently by my University of Michigan colleagues who describe the Premier experience in this area. What has worked is a more egalitarian “pay for participation” strategy initiated by Blue Cross Blue Shield of Michigan several years ago, referred to as Collaborative Quality Initiatives, and described in these pages (page 18). Using this approach, the costs of quality improvement are largely underwritten by the third party payer, Blue Cross Blue Shield of Michigan (BCBSM), and payment is made equally to hospitals on the basis of their participation in collaborative...

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