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What organizations participate in Bridges
to Excellence?
Participating organizations include NCQA
among its charter members and a diverse coalition of
physicians, health plans, quality experts and consultants
advance the pay-for-quality concept. Charter employers
include General Electric, Ford Motor Company, UPS, Procter
& Gamble and Verizon, all of which offer bonus payments
to physicians who deliver high-quality care to their
employees.
What organizations administer the program
and what are their respective roles?
The National Committee for Quality Assurance
(NCQA) selects which physicians qualify for awards based
on evaluating and verifying their data. NCQA is the
leading independent organization providing information
that allows purchasers and consumers of health care
to distinguish among health plans and physicians based
on quality of care.
MEDSTAT acts as overall program
manager and is in charge of distributing bonus payments.
Michael Pine and Associates in
the Diabetes Care Link and Cardiac Care Link programs,
helps participating physicians risk adjust their data
to account for the relative health of the patients they
treat.
In addition, Partners Community Healthcare,
Inc., the Lahey Clinic and the Cincinnati Children’s
Hospital Medical Center, all among the nation’s
most highly regarded medical institutions, played important
roles in shaping the initiative.
Who is eligible for Bridges to Excellence?
Physicians who treat employees or covered
family members of the participating employers may receive
bonus payments and recognition under the initiative.
I am interested in learning more about
the metrics involved in STEEEP. For example, how does
Bridges to Excellence define and measure "S- Safety,
T- Timely, E- Effective"...etc., and how is this information
reported?
The definition of STEEEP is included in the IOM's
report, Crossing the Quality Chasm, which we have referenced
in the literature/reference list. The report has a full
description of what each concept represents. We believe
we're impacting all of these through the combinations
of our programs and the measurement of provider performance
against POL, DCL, CCL and the patient experience of
care. In fact, the programs were designed using the
STEEEP criteria as "CTQs". One example would be the
e-prescribing and e-ordering module in PPC as helping
to significantly decrease drug-related errors and improving
the safety of patient care. Another example is the measurement
of clinical outcomes for patients with diabetes or cardiac
disease as having a very significant impact on the effectiveness
of care. Finally, the patient experience of care survey
that we are collecting and reporting impacts the patient-centeredness
of care.
What is the relationship between HealthGrades
and Bridges to Excellence?
HealthGrades supports the Bridges to Excellence
Program by building and maintaining the Physician Quality
Ratings Website. This includes gathering and scoring
patient satisfaction data through Bridges to Excellence
surveys.
Does Bridges to Excellence use any
HealthGrades data?
No, data comes from Bridges to Excellence's
other partners such as Medstat and The National Committee
for Quality Assurance (NCQA). HealthGrades builds, hosts,
and maintains the Physician Quality Ratings Website.
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Diabetes
Care Link
What is Diabetes CareRewards?
Diabetes CareRewards is an online program
specifically designed for patients diagnosed with diabetes.
Industry research has shown that people with diabetes
are concerned about eating well, minimizing stress,
staying active, and finding resources to manage their
condition. Diabetes CareRewards provides online personalized
support and incentives to help you achieve an optimal
level of diabetes health. This new resource promotes
the achievement of target diabetes goals to improve
your health and prevent diabetes complications. By working
to optimally manage your diabetes, you'll be eligible
to earn points via CareRewards
Why is Bridges to Excellence targeting
diabetes?
According to the American Diabetes Association,
more than 17 million Americans suffer from diabetes,
ranking it among the nation’s most serious health
issues. Employees suffering from poorly controlled diabetes
typically miss about 12 days of work per year due to
the illness, as compared to just two days for diabetics
whose illness is well controlled.
Who sponsors the Diabetes CareRewards
program?
A powerful coalition of employers and
health plans has joined together to promote the achievement
of target diabetes goals to improve the quality of diabetes
care and prevent diabetes complications.
How do I find physicians participating
in this program?
All physicians achieving certification
or recognition will be promoted through the Diabetes
CareRewards website. If you find a physician from whom
you wish to seek services, be sure to check with your
health plan to verify that the physician is covered
within your network.
What do physicians need to do to qualify
for bonus payments?
To qualify for bonus payments, physicians
will measure the percentage of their diabetic patients
whose blood pressure, blood sugar and lipid levels are
sufficiently measured and controlled. The performance
measures for Diabetes Care Link are based on those used
in the American Diabetes Association/NCQA
Diabetes Physician Recognition Program (DPRP).
Aggregate performance results indicate
that DPRP-recognized physicians provide quality care
and have improved care delivery between 1997 and 2001:
- The average rate of diabetes patients who had
Hemoglobin A1c (HbA1c) levels of less than 8 percent
increased from 50 percent to 70 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 properly
controlled low-density lipoprotein (LDL) cholesterol
gained 35 percentage points (37 percent to 72 percent).
- The rate of diabetes patients monitored for kidney
disease rose from 60 percent to 84 percent.
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What is the value of the bonus payments?
Physicians meeting the necessary thresholds
will receive a yearly bonus of $80 for each of their
diabetic patients covered by one of the participating
employers. For example, a physician who treats 150 diabetic
employees or family members would receive a $15,000
year-end bonus.
What is the difference between a certified
and a non-certified doctor?
A certified physician has demonstrated
good outcomes in the management of patients with diabetes.
Good outcomes in diabetes care is achieved by successfully
completing the requirements for certification or recognition
of the Diabetes Physician Recognition Program (DPRP)
administered by the National Committee for Quality Assurance
(NCQA) and sponsored by the American Diabetes Association
(ADA).
Do I have to change physicians to participate?
No. You do not have to change doctors
to be eligible to use the Diabetes CareRewards website
or participate in the Diabetes CareRewards program.
Are there any other facets to Diabetes
Care Link?
Yes. Diabetes Care Link will also include
a reward program to encourage employees and family members
to take a more active role in managing their condition.
In addition, patients with diabetes will be eligible
for tools, support and information. By using these tools,
they may receive incentives such as cash, discounted
co-payments or other rewards.
Where is Diabetes Care Link being piloted?
Diabetes Care Link is being pilot tested
in Cincinnati, Ohio, Louisville, KY. and Boston, Mass.
The Bridges to Excellence coalition estimates that approximately
6,000 employees or dependents with diabetes live in
each of these markets.
With healthcare costs rising, how can
Diabetes CareRewards be offered to me?
When a patient and physician work together
for better health, costs go down for everyone.
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Cardiac
Care Link
Why is Bridges to Excellence targeting
cardiovascular care?
According to the American Heart Association/American
Stroke Association, more than 60 million Americans have
one or more types of cardiovascular disease. It is the
leading cause of death in the United States.
What do physicians need to do to qualify
for bonus payments, when available?
Cardiac Care Link is similar to Diabetes
Care Link in that it will ask physicians to measure
their performance in key areas of care. Physicians who
meet the necessary thresholds will receive financial
incentives for each of their cardiovascular patients
covered by one of the participating employers. Final
measures for Cardiac Care Link will be released later
in 2003; they will be based on those used in the Heart/Stroke
Recognition Program (HSRP) developed by the American
Heart Association/American Stroke Association and NCQA.
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Physician
Office Link
Why is Bridges to Excellence targeting
office systems?
Systematic processes contribute to improvements
in health care. Physicians who use systematic processes
are better able to:
- Monitor their patients' medical histories
- Work with patients over time, not just during
office visits
- Follow up with patients and with other providers
- Manage populations, not just individuals, using
evidence-based care
- Encourage better health habits and self-management
of medical conditions.
- Avoid medical errors
What standards are in Physician Office
Link?
NCQA has developed Physician Practice
Connections (PPC), the performance assessment for the
Bridges to Excellence rewards program, Physician Office
Link. PPC assesses office practices' performance in
the areas of clinical information systems, patient education
and support and care management.
Meeting PPC standards means that practices
have connections--to information, to patients, to other
practitioners, to evidence. The connections in PPC take
several forms, and NCQA evaluates three overlapping
categories of standards:
Clinical Information Systems/Evidence-Based
Medicine:
How does the practice use information to keep track
of patients' treatments, follow up on tests, check
medications and use researched standards of care?
Patient Education and Support:
How does the practice use resources and referrals
to help patients manage their own health? How does
the practice measure and improve quality?
Care Management:
How does the practice actively help patients with
chronic conditions and patients with very complex
problems maximize their health and prevent hospitalization?
What do physician practices need to do to qualify
for bonus payments?
To pass NCQA's Physician Practice Connections
program, practices must submit data in any one of the
three performance areas above. To qualify for full Physician
Office Link rewards, practices must submit data and
obtain a three-year recognition in each of the three
performance areas.
Which episodes of care are included
in the POL evaluation on the attached PowerPoint slide?
Are they the same episodes used in evaluating DCL and
CCL? Or does the average cost per episode include all
episodes?
These are all episodes and so include anything from
a cold to a broken leg or a chronic condition. There
are several episodes per patient as opposed to the DCL/CCL
analyses which only include the chronic illness and
have year-long episodes. We are conducting a supplemental
analysis that will look at the differential impact on
specialists as opposed to PCPs.
What will be the timing of the 2006
rollout of the new POL 2.0 reward structure? (For
example if the Plan would like to time any announcement
of their proposed POL rollout accordingly to avoid any
discrepancy between the Plan's announced rewards and
the rewards listed on the BTE Web site)
POL v 2.0 is going through a last review
in early December. It will then need to be Alpha and
Beta-tested to establish an appropriate scoring. Broad
use may begin as early as Q2 2006
How are the Physician Office Link rewards
determined?
After a practice achieves a passing score
on any one or all of the Physician Practice Connections
modules, it is eligible to receive a reward for each
Bridges to Excellence employee or family member who
receives care at the practice. The amounts of the rewards
vary depending on the modules passed.
What do physicians stand to gain by
participating in Bridges to Excellence?
Top-performing doctors could see income
gains of up to 10 percent. In addition, participating
physicians are highlighted in provider directories,
helping employees and their families identify those
doctors who are best suited for treating particular
illnesses, or who have exemplary office systems for
tracking care.
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