Bridges to Excellence

BTE Coalition FAQ's

Do I need to hire an additional staff person to coordinate BTE activities for my organization?

This will vary by each market but in a typical situation there is a project leader who is in charge of activities such as overseeing, managing, coordinating and providing operational leadership. In some cases, a coalition may also take one some day-to-day BTE management responsibilities, which could create a need for additional staff resources. Coalitions interested in implementing BTE are encouraged to contact BTE staff and NBCH to discuss their particular circumstances.

What services are provided by the BTE Administrator (formerly general contractor) in exchange for the annual administrative fee?

The BTE Administrator is responsible for most day-to-day BTE administrative matters, though they may divide some of this work with the coalition. Depending on your contract, an Administrator may provide one or more of the following services:

Communication Services
(e.g., BTE 1-800 number, Provider mailings, Physician contact database)Invoice & Reward Payment)
(e.g., Calculate and invoice for reward, Banking arrangement, Send consolidated check to Physicians)

Reporting/Evaluation
(e.g., Consolidated monthly evaluation reports, Patient and physician surveys)

Regional Management
(e.g., Conference calls/notes, Facilitation of market decisions, Program promotion)

Market-wide Attribution & Processing
(e.g., Merge and link plan physician lists, create market "Master Physician List" (MPL) of reward eligible physicians, Create market-wide physician patient counts across plans, automate file flows among stakeholders)

How do we ensure HIPAA compliance in this model?

Data use and confidentiality agreements between employers, contractors & health plans are HIPAA compliant.

As an employer, what do I need to ask my health plan to do? Will the BTE Administrator work with the health plan directly once I make the necessary introductions & sign the appropriate agreements?

This varies by market. You may be asked to have your health plan(s) provide requested data to the BTE Administrator as defined by the region.

In addition, coalitions and the BTE Administrator will work with the health plan(s) to develop physician recruitment strategies (i.e., outreach to recognition) depending on the agreement of that specific region.

Will the BTE Administrator communicate directly with my employees?

There will be no communication between BTE Administrator and employees in regards to POL, DCL and/or CCL.

What information can I expect to receive from BTE Administrator once the program is live?

This will vary by market, but once the program is live, examples of information that you may receive from the BTE Administrator include: communication services and program reporting.

How are administrative fees & practice reward payments allocated across employers in a region?

Administrative fees will depend on the specific market, however each employer is billed by the BTE Administrator according to the number of that employer's patients who are seeing recognized BTE physicians in that specific market.

How are administrative fees and practice reward payments billed to my organization?

Billing will vary by market; however, the BTE Administrator determines cost (based on contracted per patient rate) and administers bills quarterly. The BTE Administrator will invoice to accounts payable, collect payments & issue consolidated reward checks to each practice.

How are administrative fees and practice reward payments paid by my organization?

After collecting payments, the BTE Administrator will send out a consolidated reward check to each recognized practice.

How much rewards have been paid out (dollar max including explanation of 20K per year and 50K lifetime)? For example, have any physicians reached the maximum reward amount in their markets?

As of August 2005, a total of $1.9M has been rewarded to over 1,100 physicians. Caps are implemented because BTE is a quality improvement initiative; the program is not intended to become a 2nd source of income/salary for physicians. No physicians to date have reached the maximum reward amounts.

How does this all happen mechanically from an employer perspective?

The majority of BTE related operations will be performed through the BTE Administrator and business coalition, as well as an employer/licensee staff member, or both. The participating employer needs to do very little on a day-to-day basis. However, employers can provide leadership to bring other employers into BTE, to educate physicians and employees about the program. Also, the employer should communicate to its employees the benefits of seeking care from physicians providing recognized quality care.

What are the requirements for the data file between the health plan and the BTE Administrator?

This varies by market, overall BTE Administrator will be requesting data from the health plan by providing data requirements and working with plans to develop data file; employers activities include approving the Data Use Agreement.

How will I know how many of my employees have diabetes and are part of the program?

If an employer is participating in a region that is implementing the Diabetes Care Link (DCL) program, the invoice from the BTE Administrator will indicate the number of diabetic patients that are seeing BTE-recognized doctors.

What do I have to do as a participating employer? What are the resource requirements?

Employers are expected to provide strategic leadership by offering input, direction and feedback on strategy & operational BTE issues. This typically requires a project leader working in conjunction with a regional steering committee consisting of employers, health plans and other stakeholders.

How will I know which physicians in the area my employees see?

You may have internal data systems that will provide such information based on employment documentation completed by your employees. Additionally, typically a BTE Administrator collects data, attributes patients to physicians and provides employers a "Master Physician List" or MPL listing (unidentified) consisting of patient counts and quality recognized physicians names.

Who is responsible for tracking program related information, for example physicians who receive recognition, the number of my employees seen by these physicians, which physicians are eligible for rewards, the total amount of rewards payments due, etc.?

This varies by market, however in a typical situation the responsibilities of tracking program related information lay with the BTE Administrator or business coalition.

How have employers benefited from this program in other markets?

Initial data is still preliminary, but early data indicates that certified physicians tend to be more efficient & provide consistent treatment, with calculated savings of approximately 10-15%Bridges to Excellence has performed detailed program evaluations that are publicly available for download. Please visit www.bridgestoexcellence.org.

Why should I agree to participate? What will my organization get out of this?

By paying-for-performance in health care, BTE believes employers will pay less overall healthcare costs for their employees. Employers will further benefit since their employees will be seen by nationally recognized physicians, providing clinically guideline based standard care. Doctors will receive incentives based on performance against key measures of health care effectiveness. Providing care for employees with chronic conditions is expensive. Employees with poorly controlled diabetes miss an average of twelve days of work per year due to the illness, compared to just two days of lost time for diabetics whose illness is well controlled. Savings will be realized by minimizing complications, improving care, and avoiding lost work and lowered productivity.

How are physicians notified about the program?

The BTE Administrator or coalition conducts initial targeted and customized mailings with patient counts and potential reward amounts when the program starts. Afterwards, physicians are notified via continuous recruitment effort by local market representatives (phone, office visits, meetings etc).