Bridges To Excellence Leveraging HIT in Rewarding Quality Health Information Technology Summit October 22, 2004 Jeffrey Hanson, MPH Regional Healthcare Manager, Verizon Communications Board Executive, Bridges to Excellence BTE. Bridges to Excellence is a program designed to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care. Quality is measured uniformly using nationally accepted standards, collected by an independent third party NCQA Quality measures are focused on actuarially sound performance criteria that provide an opportunity for a positive ROI for payers in a fee-for-service environment What were after is a significant reengineering in the processes of care.
Bridges To Excellence, Proprietary & Confidential Bridges to Excellence: co-designed by employers and providers A multi-stakeholder approach to creating incentives for quality Employers, health plans, consumers, physicians, and group practices Mission Improve quality of care through rewards and incentives that: encourage providers to deliver optimal care, and encourage patients to seek evidence-based care and self-manage their own conditions Focus Office practices, diabetes care, cardiac care Roll-out in selected markets Program costs paid by participating employers Bridges To Excellence, Proprietary & Confidential BTE Programs principles consistent with national purchaser initiatives Rewards have to be meaningful and positive (if actuarially supported), not simply punitive, and result in a positive sum game
Pay rewards AFTER physicians have demonstrated high performance Encourage employees to seek out better performers and create incentives for better self-care Use independent national accrediting organization to assess and recognize provider performance on a community-wide (not just plan-specific) Keep pushing for tougher standards Keep demanding complete accountability for use of resources and delivery of outcomes Bridges To Excellence, Proprietary & Confidential We have three programs that are operational now NCQA Measure set Physician
Activation Consumer Activation Physician Office Link (POL) Physician Practice Connections (PPC) Up to $50 pmpy Physician-level report card, and patient experience of care survey Diabetes Care Link (DCL) Diabetes Provider Up to $100 pdppy Recognition Program (DPRP) Diabetes care
management tool, and rewards for care compliance Cardiac Care Link (CCL) Heart Stroke Up to $160 pcppy Recognition Program (HSRP) Cardiac care management tool, and rewards for care compliance Bridges To Excellence, Proprietary & Confidential BTE uses nationally recognized physician recognition programs Structure (PPC): Patient safety e-prescribing Guideline-driven care EHRs Focus on high-cost patients Care coordination Improved compliance Patient education & support
NCQA Process & Outcomes (DPRP & HSRP): HbA1Cs tested and controlled LDLs tested and controlled BP tested and controlled Eye, Foot and Urine exams Bridges To Excellence, Proprietary & Confidential LDLs tested and controlled BP tested and controlled Use of aspirin Smoking cessation advice BTE Incentives Offices meeting Passing Score in: Any Module Two out of three Modules All three
Modules POL Clinical Information System Patient Education & Support Y1 $50 Y2 $20 Y3 $10 Y1 $50
Y2 $50 Y3 $30 Y1 $50 Y2 $50 Y3 $50 DCL/CCL Care Management 20% of bonus is withheld until practice meets DCL and/or CCL (depends
on whether attribution ids diabetics and/or cardiac patients) Doc gets full POL bonus plus extra $80 for each diabetic and cardiac patient when meeting CCL/DCL A top scoring practice can earn up to $20K per doc/year Bridges To Excellence, Proprietary & Confidential The process for recognition and rewards is straightforward Physicians apply for recognition with NCQA NCQA send notify of physician being recognized to Medstat Medstat looks up physician/patient attribution by BTE Participant & Invoices for rewards BTE Participant pays reward to Medstat Medstat bundles Participant payments and pays physician Bridges To Excellence, Proprietary & Confidential
The rewards are designed to encourage adoption AND use of better systems 3 PCP Practice with 1000 patients covered by the program: 3.5% are diabetic patients 2.5% are cardiac patients Practice receives total of $54,800: $40 * 1000 = $40,000 for meeting PPC measures (POL) $80 * 60 + $10 * 1000 = $14,800 for meeting DPRP & HSRP measures (DCL & CCL) Purchaser saves a total of $55,000 less program costs ($6 pmpy) Bridges To Excellence, Proprietary & Confidential In both Cinci and Lville weve found that DPRP docs are better 2 2 1.5
0.5 1 Ingenix, Humana & NCQA, Feb. 2004 1.5 Effective docs show less variation in cost of care delivered Efficient docs are at least 25% more efficient than the average, resulting in savings of at least $600/patient/year Bridges To Excellence, Proprietary & Confidential 2 Preliminary data confirm savings for NCQA recognized physicians Endocrinologists: NCQA recognized: $1,747 Not recognized: $1,989 PCP's NCQA recognized: $1,394 Not recognized: $1,627 Bridges To Excellence, Proprietary & Confidential
10% to 15% savings translates to $500 to $600 on total cost of care for patients with diabetes. Overall savings range from $240 to $550 ~ $350 BTE is live in four markets BTE Markets Cincinnati, OH / Louisville, KY Boston, MA Albany / Schenectady, NY Launch Date June 2003 February 2004 May 2004 Program(s) DCL
DCL, POL POL, DCL, CCL # of Employers 7: GE, Ford, UPS, P&G, Humana, CCHMC, City of Cinci 3 (6): GE, Raytheon, Verizon, (IBM, AZ) 4: GE, Hannaford Bros, Verizon, Golub # of Plans 6: Humana, Aetna, UHC, Anthem, BCBS (OH, AL) 5: Tufts, Harvard, UHC, BCBS(MA, AL),
3: MVP, CDPHP, UHC # of Covered Lives 200,000 (7,000 Diabetes) 85,000 (3,500 Diabetes) 45,000 (2,000 Diabetes; 1,000 Cardiac) Bridges To Excellence, Proprietary & Confidential Results to Date Bridges To Excellence, Proprietary & Confidential Consumers are also engaged through our report card web site High-level roll-up of physicians overall performance Distinguishes relative performance of physicians within
each level Bridges To Excellence, Proprietary & Confidential Effectiveness results come from NCQA, patient experience of care from employees Bridges To Excellence, Proprietary & Confidential Key lessons learned are applied to all markets to improve performance Moving docs to reengineer takes a combination of positive and negative incentives (bonus and threat of losing business) Getting multiple purchasers to coordinate activities is tough, especially when they are used to plans doing everything for them You have to be nimble and quick to adapt to succeed in changing the market Bridges To Excellence, Proprietary & Confidential
Our efforts have been incorporated in other national initiatives HRPA the coalition has agreed to use the BTE & Leapfrog-defined measure sets in its initiative, and will only contract with plans that agree to use them CMS were working with CMS on three of its demos: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched up Health Plans health plans like Tufts in MA have already launched premium-based products that use these BTE principles in measuring physician performance. Others like Aetna and UHC are adopting the concepts and measures in their programs Bridges To Excellence, Proprietary & Confidential BTE Summary Focused on physician care reengineering Processes of care that are assessed include health information technology (i.e. fully functional & interoperable EHR), patient education and care management
Program launched and operated in four markets. Health information technology being rewarded now in two markets (MA & NY) NCQA assesses if practices meet the BTE criteria through the PPC program, which is being revised into Version 2.0, adding in MCMP requirements Bridges To Excellence, Proprietary & Confidential
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