PHYSICIANS, BUSINESS, GOVERNMENT & INDUSTRY EMBRACE COMMON STRATEGY TO IMPROVE HEALTH CARE: PAY-FOR-PERFORMANCE

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 surface."

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
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."

Business Coalitions
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 BlueShield
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 care decisions."

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.

###

Back to Top