PHYSICIANS, BUSINESS, GOVERNMENT &
INDUSTRY EMBRACE COMMON STRATEGY TO IMPROVE HEALTH CARE:
WASHINGTON - The Bridges to Excellence (BTE)
Coalition today announced a series of major new pay-for-performance
(P4P) initiatives involving the Medicare program, various
business coalitions, a large national plan and an important
regional BlueCross BlueShield plan. Together these initiatives
cover more than 10 states and involve well over 2 million
people. More than 80 other pay-for-performance efforts
are currently underway nationwide. Mounting evidence
that pay-for-performance drives improvement has made
it a popular approach to health care reform, a significant
departure from two years ago when the Bridges to Excellence
coalition was getting started. BTE's pay-for-performance
efforts build off of physician recognition programs
designed by the National Committee for Quality Assurance
(NCQA) and its partners, the American Diabetes Association
(ADA) and the American Heart Association/American Stroke
Association. The three P4P programs under Bridges to
Excellence are Diabetes Care Link, Cardiac Care Link
and Physician Office Link.
"Enthusiasm is growing for pay-for-performance
initiatives in all regions of the country," said
BTE President and Verizon Regional Healthcare Manager
Jeff Hanson. "Bringing government, industry, physicians
and businesses together around quality health care issues
and holding the health care industry to the highest
standards of excellence will benefit all Americans."
Margaret E. O'Kane, President of NCQA, echoed that
sentiment. "It's a concept that sells itself -
pay good doctors more and encourage employees to go
see those doctors so they get better faster. The rewards
for both patients and doctors are right there on the
The Centers for Medicare & Medicaid Services (CMS)
is currently developing a number of pay-for-performance
programs. Its strong support of the concept is among
the biggest factors driving acceptance of P4P, as is
evidenced from several early programs that the strategy
drives meaningful improvements.
Among doctors participating in the longstanding NCQA/ADA
Diabetes Physician Recognition Program (DPRP) (the foundation
of one BTE P4P program - Diabetes Care Link), performance
on a range of clinical measures has improved 50% or
more over the past seven years.
More recently, independent studies done by three national
health plans found that physicians participating in
the BTE Diabetes Care Link program offered care that
was substantially more consistent with best practice
guidelines. These physicians also delivered care at
a 10% to 15% lower cost than non-DPRP recognized physicians.
The majority of the savings come from fewer hospitalizations
and fewer patient visits to the emergency room.
CMS is also looking towards the BTE Physician Office
Link program as a possible element in its forthcoming
Medicare Care Management Performance Demonstration project,
an initiative which will promote the adoption and use
of health information technology to improve the efficiency
and quality of patient care for chronically ill Medicare
patients. Doctors who meet or exceed performance standards
established by CMS in clinical delivery systems and
patient outcomes will receive performance payments for
managing the care of eligible Medicare beneficiaries.
The effort, scheduled to begin later this year, will
involve hundreds of doctors in medical practices in
Arkansas, California, Utah and Massachusetts. In many
of these States, CMS will collaborate with BTE and other
private pay-for-performance initiatives.
"We are 100 percent committed to promoting pay-for-performance,"
said Mark McClellan, M.D., Ph.D., CMS Administrator.
"Engaging patients, improving evidence based care
and efficiencies, controlling costs, promoting the use
of information technology, broad performance measurement
and reporting - pay-for-performance will help make all
of these a reality."
The BTE effort establishes a direct link between pay-for-performance
and the adoption of information technology, by rewarding
physicians who make related investments--a strategy
that has won praise from the nation's chief health care
information technology advocate, David Brailer, M.D.,
Ph.D., National Coordinator for Health Information Technology.
"Pay-for-performance initiatives, such as these,
will help reduce economic barriers to the adoption of
electronic health records," said Brailer. "Electronic
health records will in turn, help physicians improve
quality and patient safety."
This year's report by the Medicare Payment Advisory
Commission recommends that CMS widen its pay-for-performance
efforts and focus on encouraging adoption and use of
health information technology, as exemplified by the
BTE Physician Office Link program.
Family Physicians Applaud Effort
The American Academy of Family Physicians (AAFP) has
long encouraged its members to adopt information technology
and add quality improvement efforts to their practices.
"This program is tangible evidence that physicians
who install systems for better care may be rewarded,
said Mary Frank, M.D., President of the American Academy
of Family Physicians. "The AAFP supports pay-for-performance
programs that engage the patient and provide positive
incentives for physicians. The BTE program has a clear
focus on office process improvement, not just outcomes
of care. We look forward to working with the BTE Coalition
in the future."
The four coalitions launching BTE-related projects are
located in Illinois (two in Illinois), Colorado and
Arkansas. The coalitions, through a licensing arrangement
with BTE, have begun talking with employers and estimate
launching customized programs in their respective markets
later this year. Business coalitions are well suited
to coordinating such incentive programs - by coordinating
activities among employers, they can pool resources
and streamline related operations, thus making the efforts
more attractive to employers and physicians. All four
coalitions are members of the National Business Coalition
on Health (NBCH), a 70-coalition member strong organization
that strongly supports pay-for-performance.
"We're in the early part of a gold rush here where
everyone's experimenting with pay-for-performance in
health care," said Andrew Webber, president and
CEO of NBCH. Our focus now is on operationalizing the
process in different settings and at different levels
of the system."
United Healthcare, CIGNA & CareFirst BlueCross
Last July, United Healthcare became the first health
care company to license the BTE model, working with
employers in Omaha, St Louis, Dayton and South Florida
to offer network doctors certain incentives for earning
NCQA recognition. "BTE is a wonderful way to recognize
and reward physicians for following evidenced based-guidelines
and adopting recognized best practices," said Vince
Kerr, M.D., President, Care Solutions, United Healthcare.
"It also allows patients who are making care decisions
to factor that important information into their decisions.
It's a win for both doctor and patient. I think that
explains some of the excitement we are seeing in markets
where this is being launched."
CareFirst BlueCross BlueShield recently became the
second health plan to license BTE, and the first to
fund provider incentives itself. Carefirst BlueCross
BlueShield will pay up to $50 per patient to reward
physicians who meet NCQA's Physician Practice Connections
criteria (which promotes the use of information technology
to improve safety and standardize care). A not-for-profit
health plan serving 3.2 million members in Maryland,
Virginia and the District of Columbia, CareFirst BlueCross
BlueShield will also reimburse physicians for the costs
associated with pursuing NCQA recognition. CareFirst's
BlueCross BlueShield demonstration project will cover
16,000 CareFirst BlueCross BlueShield members.
"BTE is where obligation and opportunity meet,"
CareFirst BlueCross BlueShield President and CEO William
L. Jews. "Every health plan has an obligation to
deliver the best possible care and service. Through
BTE, we have the opportunity to meet that obligation
in a way that benefits both our patients and our physicians.
Doctors get financial support for upgrading their systems
and patients get more information to help make health
CIGNA HealthCare is the latest plan to license the
Bridges to Excellence program and is working with employers
to pursue a pay-for-performance effort in Phoenix and
North Carolina and may expand to other markets as well.
"Expanding our current high performance network
efforts (CIGNA Care Network) to include the NCQA
Physician Recognition programs and a pay-for-performance
program strengthens the depth and breadth of the information
we provide to our members while rewarding physicians
for high quality care," added Jeff Kang, M.D.,
Chief Medical Officer for CIGNA HealthCare.
About Bridges to Excellence
The Bridges to Excellence coalition is a not-for-profit
organization created to encourage significant leaps
in the quality of care by recognizing and rewarding
health care providers who demonstrate that they deliver
safe, timely, effective, efficient and patient-centered
care. In addition to NBCH, Bridges to Excellence participants
include large employers, health plans, the National
Committee for Quality Assurance, MEDSTAT and WebMD Health,
among others. The organizations are united in their
shared goal of improving health care quality through
measurement, reporting, rewards and education. Additional
information is available at www.bridgestoexcellence.org.
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