ABOUT ANTHEM BLUE CROSS 2010-2012 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are regis- tered marks of the Blue Cross Association. Additional information about Anthem Blue Cross is available at www.anthem.com/ca. Also follow us on Twitter at www. twitter.com/healthjoinin, in Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

ABOUT THE REGIONAL HOSPITAL ASSOCIATIONS The regional hospital associations are not-for-profit 501(c) (6) regional trade asso- ciations comprised of hospitals and health systems, related professional associa- tions and associate members with a common interest in improving the operating environment for hospitals and improving the health status of the communities they serve. Combined, the three associations represent 95% of all hospitals in the state. Our mission is to serve the political, economic, informational and educational needs of hospitals in our regions, and improve the quality and accessibility of health care services and thereby improve the health status of communities. For more information please visit each regional association’s website: Hospital Association of San Diego & Imperial Counties, www.hasdic.org Hospital Association of Southern California, www.hasc.org Hospital Council of Northern and Central California, www.hospitalcouncil.net

ABOUT NATIONAL HEALTH FOUNDATION National Health Foundation (NHF) is an independent, tax exempt 501 (c)(3) public charity dedicated to improving and enhancing the healthcare of the underserved by developing and supporting innovative programs that 1) can become independently viable, 2) provide systematic solutions to gaps in healthcare access and delivery, and 3) have the potential to be replicated nationally. For more information, visit: www.nhfca.org

For more information on Patient Safety First, visit: www.nhfca.org/PSF “This three year Patient Safety First program demonstrates that when over 180 hospitals identify a problem, utilize a common data base and work DEAR HEALTHCARE PARTNERS: collaboratively to make hospitals safer, PATIENT SAFETY FIRST… Anthem Blue Cross and the hospitals, physicians, and other significant progress can be made.” A CALIFORNIA PARTNERSHIP FOR HEALTH providers who have joined us, share a common mission – to Patient Safety First is an innovative partnership working to improve help Californians get healthy and stay healthy. J. Eugene Grigsby, III, CEO National Health Foundation the quality of care provided to Californians, save lives and reduce Over the past three years, Anthem Blue Cross and National healthcare costs. With over 180 hospital participants, Patient Safety Health Foundation have partnered with the Hospital Association First is the largest statewide collaborative in the nation. of Southern California, the Hospital Council of Northern and Not only is Patient Safety First unique in its size and scale, but it is Central California, and the Hospital Association of San Diego & distinctive in that it brings together a health plan, hospital associa- Imperial Counties to create the nation’s largest statewide collabo- tions, a non-profit organization and private and public hospitals as rative effort focused on patient safety. partners in an effort to improve care, health outcomes and reduce Hospitals participating in Patient Safety First…a California Part- healthcare costs. nership for Health have saved more than 3,500 lives and avoided Anthem Blue Cross generously provided $6 million dollars over more than $63 million in unnecessary medical costs over the last three years to fund this initiative. Patient Safety First partners three years. include the Hospital Association of Southern California, Hospital Council of Northern and Central California, Hospital Association of By working together, we have achieved amazing results. While San Diego & Imperial Counties, National Health Foundation and we have much to celebrate, there is still much work to do. I hope Anthem Blue Cross. Each organization plays an important role in you will continue to support our Patient Safety First efforts as we the strategic planning and implementation of Patient Safety First. embark on Phase 2 of this collaborative endeavor. Together we can make California a leader in providing safe and quality care. PEER TO PEER LEARNING

Sincerely, To facilitate improvement within hospitals, Patient Safety First adopted components of the Institute for Healthcare Improvement Breakthrough Series Collaborative Model for Achieving Break- through Improvement developed in 1995. This model is a validated learning system that brings together a large number of teams from hospitals to seek improvement in a focused topic area. Peer Pam Kehaly to peer learning occurs through multidisciplinary hospital teams, President, Anthem Blue Cross networking and exposure to expert speakers. Hospital teams use the knowledge gained through Patient Safety First programs to implement best practices in their hospitals. EARLY ELECTIVE VENTILATOR ASSOCIATED CENTRAL LINE BLOOD SEPSIS DELIVERIES PNEUMONIA (VAP) STREAM INFECTIONS (CLBSI) MORTALITY Early elective deliveries are deliv- VAP is a respiratory infection that CLBSI is a primary laboratory Sepsis is a serious bloodstream eries that occur between 37 and must have developed more than confirmed bloodstream infection in infection that can rapidly become 39 weeks of gestation that are not 48 hours after the patient was a patient with a central line at the life-threatening. Severe sepsis and medically indicated. Early elective intubated. VAP is the leading cause time of (or within 48-hours prior septic shock are major healthcare deliveries carry significant risks for of death amongst hospital-acquired to) the onset of symptoms and the problems, affecting millions of the baby with no known benefit infections and prolongs time spent infection is not related to an infec- people around the world each year, to the mother1. Recent studies on the ventilator, length of ICU tion from another site2. According killing one in four (and often more), demonstrate that early elective de- stay, and length of hospital stay to the IHI, CLBSI continues to be and increasing in incidence (1–5)4 . liveries can have negative medical after discharge from the ICU1. one of the most deadly and costly Early aggressive treatment increas- consequences such as increased hospital-associated infections in es the chance of survival. risk of cesarean section, higher risk the US3. of postpartum complications, and higher risk of neonatal morbidity and mortality.

PSF THREE YEAR GOAL: PSF THREE YEAR GOAL: PSF THREE YEAR GOAL: PSF THREE YEAR GOAL: To reduce elective deliveries To reach a rate of zero VAP To reach a rate of zero CLBSI To reduce sepsis mortality to prior to 39 weeks gestational infections in participating infections in participating 30% or less in participating age to 5% or less in partici- hospitals. hospitals. hospitals. pating hospitals. THREE YEAR OUTCOME: THREE YEAR OUTCOME: THREE YEAR OUTCOME: THREE YEAR THREE YEAR OUTCOME: There were 1.27 fewer VAP There were 0.97 fewer CLBSI There were 5.96 fewer Sepsis Elective deliveries prior to 39 cases per 1,000 ventilator cases per 1,000 central line deaths per 100 sepsis cases weeks represented 9.94% of days in 2012 (0.94) than in days in 2012 (1.27) than in in 2012 (16.62) than in 2009 all deliveries in 2010, but only 2009 (2.21), representing a 2009 (2.24), representing a (22.58), representing a 26% OUTCOMES 2.57% of deliveries in 2012, 57% significant reduction 43% significant reduction significant reduction, nearly representing a 74% significant towards the goal of a zero towards the goal of a zero meeting the goal of a 30% Since the inception of the collaborative in reduction, meeting the goal of VAP rate. CLBSI rate. decline over 3 years. 2010, Patient Safety First member hospitals 5% or less within 3 years. have shown significant improvement in four important hospital based avoidable harms’ initiatives: early elective deliveries under 39 Together these improvements have resulted in over $63 million dollars in costs avoided over the three years of weeks, ventilator associated pneumonia, COST SAVINGS the program. Moreover, reductions in sepsis mortality have resulted in an estimated 3,576 lives saved. These results demonstrate the tremendous positive impact Patient Safety First has had on moving the needle in patient central line blood stream infections and & LIVES SAVED safety across California. sepsis mortality.

1 2 3 4 March of Dimes, <39 Weeks Toolkit. Institute for Healthcare Improvement: Ventilator Bundle, 2011. CDC, April2013 CDC/NHSN Protocol Corrections, Clarification, and Additions. IHI, Central 5 Line Infection: http://www.ihi.org/explore/CentralLineInfection/Pages/default.aspx. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 PARTICIPATING HOSPITALS 2010-2012

Adventist Health - Reedley (Sierra Kings District Hospital) Doctors Medical Center, Manteca Kaiser Permanente Modesto Medical Center Monterey Park Hospital San Dimas Community Hospital St. Mary’s Medical Center Adventist Medical Center - Hanford Doctors Medical Center, Modesto Kaiser Permanente Vacaville Medical Center Northern CA Rehabilitation Hospital San Francisco General Hospital St. Rose Hospital Adventist Medical Center - Selma Downey Regional Medical Center Kaiser Permanente Vallejo Medical Center Oak Valley Hospital District San Joaquin General Hospital St. Vincent Medical Center AHMC Anaheim Regional Medical Center East LA Doctors’ Hospital Kaweah Delta Medical Center O’Connor Hospital San Joaquin Valley Rehab Hospital Sutter Tracy Community Hospital Alhambra Hospital Medical Center El Centro Regional Medical Center Kern Medical Center Ojai Valley Community Hospital Santa Barbara Cottage Hospital Tehachapi Regional District Hospital Alvarado Hospital Emanuel Medical Center Kern Valley Healthcare District Olympia Medical Center Santa Ynez Valley Cottage Hospital Torrance Memorial Medical Center Encino Hospital Medical Center Kindred Hospital - La Mirada Orange Coast Memorial Medical Center Scripps Green Hospital Tri-City Medical Center Arrowhead Regional Medical Center Feather River Hospital Kindred Hospital San Diego Pacific Alliance Medical Center Scripps Memorial Hospital Encinitas Tulare Regional District Hospital Bakersfield Memorial Hospital Foothill Presbyterian Hospital LA Metropolitan Medical Center Pacific Hospital of Long Beach Scripps Memorial Hospital La Jolla UC Davis Medical Center Barlow Respiratory Hospital Fountain Valley Regional Hospital and Medical Center La Palma Intercommunity Hospital Palmdale Regional Medical Center UC San Diego Medical Center Barton Hospital Fremont-Rideout Hospital LAC Olive View Scripps Mercy Hospital Chula Vista UC San Diego Thornton Hospital Bellflower Medical Center Garden Grove Hospital and Medical Center Lakewood Regional Medical Center Paradise Valley Hospital Seton Medical Center UCSF Medical Center California Hospital Medical Center Garfield Medical Center Lodi Memorial Hospital Parkview Community Hospital Medical Center Sharp Chula Vista Medical Center Ukiah Valley Medical Center Catalina Island Medical Center Glendale Adventist Medical Center/Adventist Health Loma Linda University Medical Center Pioneers Memorial Healthcare District Sharp Coronado Hospital University of California - Ronald Reagan Cedars-Sinai Medical Center Glendale Memorial Hospital and Health Center Lompoc Valley Medical Center Placentia-Linda Hospital Sharp Grossmont Hospital UCLA Medical Center Centinela Hospital Medical Center Goleta Valley Cottage Hospital Long Beach Memorial Medical Center Pomerado Hospital Sharp Mary Birch Hospital for Women and Newborns University of California - Santa Monica Medical Center Central Valley General Hospital Good Samaritan Hospital Los Alamitos Medical Center Pomona Valley Hospital Medical Center University of California Irvine Healthcare Chino Valley Medical Center Healdsburg District Hospital Madera Community Medical Center Providence Holy Cross Medical Center Shasta Regional Medical Center USC University Hospital Citrus Valley Medical Center - Inter-Community Hemet Valley Medical Center Marian Medical Center Providence Little Company of Mary Sherman Oaks Hospital VA Greater Los Angeles Healthcare System Citrus Valley Medical Center - Queen of the Valley Henry Mayo Newhall Memorial Hospital Marin General Hospital Medical Center - San Pedro Shriners Hospitals for Children - Los Angeles Valley Presbyterian Hospital City of Hope - Helford Clinical Hi-Desert Medical Center Marina Del Rey Hospital Providence Little Company of Mary Shriners Hospitals for Children Northern California Ventura County Medical Center Coalinga Regional Medical Center Hoag Memorial Hospital Presbyterian Marshall Medical Center Medical Center - Torrance Sierra View District Hospital Verdugo Hills Hospital Coastal Communities Hospital Hollywood Presbyterian Medical Center Mayers Memorial Hospital District Providence Saint Joseph Medical Center Silver Lake Medical Center Victor Valley Community Hospital Colusa Regional Medical Center Huntington Beach Hospital Memorial Hospital of Gardena Providence Tarzana Medical Center Southwest Healthcare West Anaheim Medical Center Community Hospital of the Monterey Peninsula Huntington Memorial Hospital Memorial Medical Center, Modesto Rady Children’s Hospital - San Diego St. Francis Medical Center Western Medical Center - Anaheim Community Memorial Hospital JFK Memorial Hospital Menifee Valley Medical Center Redlands Community Hospital St. Francis Memorial Hospital Western Medical Center - Santa Ana Community Regional Medical Center System, Concord Campus Mercy Hospital of Folsom Riverside County Regional Medical Center St. John’s Pleasant Valley Hospital White Memorial Medical Center/Adventist Health Corcoran Hospital & Walnut Creek Campus Mercy Medical Center Merced Saddleback Memorial Medical Center St. John’s Regional Medical Center Whittier Hospital Medical Center Corona Regional Medical Center Kaiser Foundation Hospital Fresno Methodist Hospital of Southern California Saint John’s Hospital and Health Center St. Joseph Hospital Dameron Hospital Association Kaiser Permanente Fremont Medical Center Mills Peninsula Health Services Salinas Valley Memorial Healthcare System St. Joseph’s Medical Center Desert Regional Medical Center Kaiser Permanente Hayward Medical Center Mission Hospital San Antonio Community Hospital St. Jude Medical Center Desert Valley Hospital Kaiser Permanente Manteca Medical Center Montclair Hospital Medical Center San Bernardino Mountains Community Hospital District St. Mary Medical Center