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Diabetes Care Link

The Diabetes Care Link (DCL) program is intended to improve the quality of care for patients with diabetes. Physicians who demonstrate they are top performers in diabetes care can earn up to $200 for each diabetic patient covered by a participating health plan and/or employer. Participants fund these incentives from the savings they achieve through lower health care costs and increased individual productivity that results from delivery of higher quality diabetes care. Therefore, DCL is a win-win-win situation for physicians, plans, employers, and patients.

To view the Diabetes Care Link (DCL) program measures click here.

Check out the Diabetes Care Analysis - Savings Estimate (PDF).

To attain the rewards available through the BTE DCL reward program, eligible physicians and physician practices voluntarily submit medical record data demonstrating that they provide high levels of diabetes care. There are three different paths available to physicians for DCL recognition:

  1. NCQA: Physicians or practices that qualify for NCQA’s Diabetes Provider Recognition Program (DPRP) assessment program will be recognized by BTE for the Diabetes Care Link (DCL) program at the corresponding level (i.e. DPRP Level I= DCL Level I). To achieve DPRP Recognition, physicians submit data on outcome and process measures for a sample of their patients with diabetes. Level I and II assessments are available through the NCQA.
  2. Automated Performance Assessment System: Physicians or practices connected to a BTE participating data aggregator (i.e. EMR vendor, Health Information Exchange, Care Management Software) may have their data submitted on their behalf to an independent Performance Assessment Organization (PAO) for an automated evaluation of their diabetes care. Physicians or practices who demonstrate that they provide high levels of diabetes care are recognized in the BTE Diabetes Care Link (DCL) program at Levels I-III.
  3. Direct Data Submission Portal: Physicians or practices may submit their data directly to IPRO, one of BTE’s independent Performance Assessment Organizations (PAOs), through its Clinical Data Portal. Data is entered into a standard file format and uploaded to the web portal for assessment of their diabetes care. Physicians or practices who demonstrate that they provide high levels of diabetes care are recognized in the BTE Diabetes Care Link (DCL) program at Levels I-III.

Does obtaining recognition improve the quality of health care?

The program is designed with an understanding that patients may seek the care of various types of practitioners-primary care (PCPs) and endocrinologists (Endos) for treatment and management of their diabetes. Accordingly, the measures reflect that physicians should do the following.

  • Provide high-quality care from the outset of patient contact.
  • Understand and consider previous treatment history to help avoid inappropriate treatment.

The program comprises a set of measures and standards, based on available clinical evidence, that promote a model of care that includes the following criteria.

  • Comprehensive patient assessment and reassessment
  • Patient education
  • Shared decision making

BTE’s DCL requirements assess process measures and outcomes representing high standards of care for patients with diabetes. BTE believes that the DCL program has the potential to significantly improve the quality of care experienced by many patients with diabetes and to reduce the financial and human burden of unnecessary hospitalizations and complications.

As seen in DPRP historical results, BTE believes that if physicians 1) know what processes and outcomes are essential, and 2) collect data on what they do and are able to review aggregate data from their patient population, care will improve.

For DPRP applicants from 1997 to 2003:

  • The average rate of diabetes patients who had Hemoglobin A1c (HbA1c) levels of less than 7 percent increased from 25 percent to 46 percent, an indication that more adults with diabetes are maintaining proper HbA1c control. HbA1c is a measure of average blood sugar over the previous three months.
  • The rate of diabetes patients who had controlled low-density lipoprotein (LDL) cholesterol below 100 mg/dl rose from 17 percent to 45 percent.

The rate of diabetes patients monitored for kidney disease rose from 60 percent to 85 percent. Data source: NCQA

What measures will be used to determine tiers of Recognition?

Given the evidence in the literature advocating the creation of physician quality reward programs that promote continuous quality improvement amongst its participants, the BTE Diabetes Care Link program is designed to include 3 levels or tiers of recognition. Assessment for recognition in all 3 tiers is based upon medical record data submitted on a core set of diabetes process measures and outcomes representing high standard of care for diabetic patients. By achieving a three-year DPRP recognition from ADA/NCQA, physicians/practices automatically get a three-year BTE DCL Level I or II recognition.

  1. Level I: Focuses on a physician-centric[i] view of measurement, looking at individual metrics summed to produce a composite score, with the inclusion of “must pass” elements for intermediate outcome control measures (i.e., BP control, LDL control and HbA1c control). Thresholds have been set to focus on above average performance.
  2. Level IIFocuses on a combination of physician and patient-centric[ii] measurements. Level II includes the measurement of individual metrics summed to produce a composite score, with the inclusion of “must pass” elements for all intermediate outcome control measures, both poor and superior. Also looks at the defect rate of care delivery across poor control measures on a per patient basis. Thresholds have been set to focus on very good performance. 
  3. Level III: Focuses on patient-centric view of measurement, looking at the defect rate of care delivery across superior control measures on a per patient basis. Physicians must demonstrate that they are using advanced processes and delivering all the right care on a per patient basis. Thresholds have been set to focus on exceptional performance.

What is the duration of Recognition?

For Diabetes Care Link (DCL) recognitions achieved on or before December 31, 2009, recognition status remains in effect for 3 years from the date on which a PAO awards recognition. Beginning January 1, 2010, the DCL recognition duration will be shortened to 2 years from the date on which a PAO awards recognition.

How will the public know which physicians have obtained recognition?

All BTE rewards-eligible and/or qualified physicians and/or practices that are recognized by a Performance Assessment Organization, such as IPRO and MNCM as providing a high quality of care in the BTE DCL program are promoted on BTE’s list of DCL recognized physicians on the HealthGrades Physician Quality Ratings website. Additionally participants going through NCQA's Diabetes Physician Recognition Program (DPRP) are promoted as recognized practices and physicians through NCQA's Recognized Physician Directory. The ability to meet these measures exhibits that the physician and/or practice delivers quality care in the areas of diabetes and system processes. To identify physicians in your area who demonstrate a high level of performance in providing care, go to one of these two directories.

Please note that some of this information such as reward amounts could be specific to a region. For market specifics, go to your local BTE region page.

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[i] Physician centric refers to performance assessment involving evaluation of physician performance based upon discrete measures (i.e. BP <130/80), which is applied across the eligible patient panel. The results provide a picture of a physician’s performance on a given measures across his or her eligible patient panel. Since the process leads to physician-focused results it is said to be “physician-centric.”

[ii] Patient centric refers to performance assessment involving evaluation of physician performance based upon composite measures, created by combining 2 or more separate discrete measures into a single measure (i.e. combining BP <130/80 and LDL <100mg/dl into 1 single measure), which is applied on a per patient basis. The results provide a picture of an individual patient’s performance on a set of measures which make–up the composite measure. Since the process leads to patient-focused results it is said to be “patient-centric.”



 

© 2003-2009 Bridges to Excellence, Inc. All rights reserved.
Bridges to Excellence does not endorse any particular product or service or any physician or physician group. Bridges to Excellence relies on third-party performance assessment organizations such as the NCQA and Quality Improvement Organizations to measure a physician or physician's group performance and ability to demonstrate that they meet certain measures of quality care.