A great way to set yourself apart, strengthen your patient relationships, and earn rewards and recognition.

The Diabetes Care Link is part of a broader collaborative effort called Bridges to Excellence whose mission is to reward quality across the health care system.

By participating in the Diabetes Care Link, you can support an important quality improvement initiative while earning rewards for providing high quality care.

Here's how the program works

First, you'll apply for certification or recognition under the Diabetes Physician Recognition Program (DPRP). This is a joint effort of the American Diabetes Association and the National Committee for Quality Assurance (www.ncqa.org), the nation’s leading health care quality organization.

You will be able to choose one of two reward tracks. The first is an annual certification track that requires the submission of outcomes data; the second is a three-year recognition track that requires the submission of process
and outcome measures. Go to DPRP measures, criteria and scoring.

Once you or your group is approved, you will be featured as a physician or group providing quality diabetes care to employees and members of participating companies and health plans. The Diabetes Care Link is sponsored by a coalition of employers, including GE, Ford, UPS and Procter & Gamble, as well as health plans like Humana, UnitedHealthcare, Aetna and Blue Cross and Blue Shield. In their efforts to direct employees to physicians who provide high quality care, you or your group will be highlighted on a Web site.

For each diabetic patient cared for by you or participating physicians in your group and covered by a participating employer, you will receive a $100 annual cash bonus. Depending on the number of diabetic patients you treat, these bonus payments may amount to thousands of dollars per year.

Help your patients help themselves! By joining the program, you and your patients can work as a team in making treatment decisions and tracking care. Patients in this program can monitor and organize their care data through an online tool. And they can earn points toward valuable incentives through the CareRewards program. The idea is to help patients manage their conditions and reduce their risk of complications … while helping you differentiate your services and earn rewards for leadership and effectiveness.

Go directly to the DPRP Web site to get application materials. Or call NCQA Customer Support at 1-888-275-7585 for more information.

Get program details and answers to Frequently Asked Questions.

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Frequently Asked Questions

Why are employers and health plans launching this initiative?

Employers recognize that physicians work hard every day to care for their patients. They also recognize that better quality of care will help keep their employees active and at work, or help them get back to work faster and in better health. To encourage high quality, evidence-based care, they want to reward physicians, using objective and validated measures to compare performance.

How will I know how many of my diabetics are covered under this program?

At the official launch of DCL, each eligible physician will receive a count of their diabetic patients employed by participating purchasers. Physicians and patient counts are identified by the health plans participating with this program, based on inpatient and ambulatory claim and encounter data for a 12-month measurement period.

In year one of the program, there will not be an appeal process. Creation of an appeal process will be considered for future years, based on experience with the first year of the program. Questions on patient counts can be directed to MEDSTAT at1-800-224-7161.

How much reward can I earn?

You can earn $100 annually per eligible diabetes patient. Your annual eligible reward amount is based on the following:

1. The number of eligible diabetes patients you treat. Eligible diabetes patients are determined by Bridges to Excellence based on inpatient and ambulatory claim and encounter data supplied by the participating health plans for the participating purchasers.
2. Obtaining 1-year certification or 3-year recognition through NCQA's Diabetes Physician Recognition Program (DPRP). If you obtain certification or recognition, you will earn $100 for each of your eligible diabetes patients.
   

Who is eligible to participate in the Diabetes Care Link (DCL) program?

The Diabetes Care Link (DCL) program is targeting physicians who have primary responsibility for managing the overall care of patients with diabetes. Physicians are eligible to participate in the DCL program if they:

1. provide primary care for 10 or more eligible diabetes patients identified by Bridges to Excellence based on inpatient and ambulatory claim and encounter data supplied by the participating health plans for the participating employers.
2. obtain 1-year certification or 3-year recognition through NCQA's Diabetes Physician Recognition Program (DPRP).
   

Physicians who treat diabetes patients due to their particular specialty practice (e.g., ophthalmology, podiatry) may qualify for the DCL program only if they provide primary care and overall care management for diabetes patients.

Group practices also may be eligible for rewards when eligible diabetes patients cannot be attributed to individual physicians (e.g., when all physicians at the group submit claims only under the group name). To be eligible for rewards, groups must provide primary care for at least 20 eligible diabetes patients. To qualify for these rewards, the group must have at least 2 group physicians apply to NCQA and a minimum average of 10 eligible diabetes patients per applying group physician. Each applying physician is eligible for an equal proportion of the practice's total possible reward.

For example, if Smith Family Practice is identified as eligible for rewards with 39 eligible diabetes patients ($3900 possible reward), the group would qualify for the rewards if the practice applies to NCQA with either 2 or 3 physicians. If the practice applies with 3 physicians, each applying physician is eligible to receive $1300 rewards (13 patients x $100). In order to receive the rewards, the group practice must obtain 1-year certification or 3-year recognition through NCQA's DPRP.

Since outcomes will be measured, will an allowance be made for physicians who treat sicker patients?

Physicians who believe they treat sicker patients may request to have their patients’ clinical data risk-adjusted. Risk-adjustment is available for the annual certification, but is not available for the three-year ADA/NCQA recognition. The existing three year DPRP initiative does not include a mechanism for risk adjustment.

In addition to the data required to apply for certification, risk adjustment will require the following information:

• Patient age, gender, height, and weight
• HemoglobinA1C, blood pressure, lipid profile, creatinine or BUN, hemoglobin or hematocrit values for dates of service PRIOR to the dates submitted in the patient sample data for certification or recognition
• Types of treatment being received by patients in the sample (i.e., insulin, oral hypoglycemics, antihypertensives, lipid lowering agents, renal dialysis)
• ICD-9-CM diagnosis codes.

Physicians may request risk adjustment for the annual certification, based on the required sample of 35 patients. For a more complete assessment of risk, physicians may also submit data for additional patients. Physicians who wish to have their patient data risk-adjusted may contact Joan DeSeno at Michael Pine and Associates, Inc., for forms, software and assistance in accessing their data in the most efficient manner possible. Ms. DeSeno can be reached by phone at 773-643-1700, by fax at 773-643-6601, or by e-mail at [email protected]. Go to Rationale and Methods for Risk-Adjusting Diabetic Outcomes.

Benefits of Participation

Will this Program improve the quality of diabetes care?

Yes, as seen in DPRP historical results, we believe 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 2002:

• The average rate of diabetes patients who had Hemoglobin A1c (HbA1c) levels of less than 7 percent increased from 25 percent to 45 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 83 percent.

Data source: NCQA

Why should I apply?

In today’s competitive health care marketplace, benchmark data for physicians, groups, and health plans is becoming very important to payers, purchasers, and consumers. By participating in the DCL and seeking certification or recognition, you will be able to review practice patterns for diabetes care and determine if improvements are needed.

How will the public know which physicians are certified or recognized?

All physicians achieving certification or recognition will be promoted through a website for patients with diabetes. In addition, physicians achieving three-year recognition will be promoted through the NCQA and ADA Web sites. Physicians who submit an application but do not achieve certification or recognition will not be publicly identified.

Is there a deadline or required date for submitting patient data for certification or recognition?

You may submit your data at any time during the year, and rewards will be paid on a quarterly basis after certification or recognition is achieved.

How does this program help my patients?

By joining the program, you and your patients can work as a team in making treatment decisions and tracking care. Patients in this program can monitor and organize their care data through an online tool. And they can earn points through the CareRewards program to stay motivated. The idea is to help patients manage their conditions and reduce their risk of complications … while helping you differentiate your services and earn rewards for leadership and effectiveness.

Application Information

What measures will be used to determine eligibility for recognition and rewards?

You may choose one of two scoring and reward tracks. The first is an annual certification track that requires the submission of outcomes data; the second is a three-year track that requires the submission of process and outcomes measures. The measures, criteria and scoring are below. To achieve three-year recognition and rewards, physicians must submit data for all of the measures. To receive a reward for one year, physicians must submit data on HbA1c, blood pressure and lipid testing.

Measures For Both 3-Year Recognition and Rewards and Annual Rewards
Measures	Goal	Points	Frequency
HbA1c* (most recent result)	93%	NA	Once per year
Proportion w/ HbA1c <8%	55%	5.0
Proportion w/ HbA1c >9.5%*	<21%	10.0
Blood pressure frequency (most recent result)	97%	10.0	Once per year
Proportion w/ BP <140/90 mm Hg	65%	5.0
Lipid profile*	85%	5.0	Annual**
Proportion with LDL <130 mg/dl*	63%	5.0
Additional Required Measures For 3-Year Recognition
Measures	Goal	Points	Frequency
Eye exam*	61%	10.0	Annual**
Foot exam	80%	10.0	Annual
Nephropathy assessment*	73%	10.0	Annual**
Total Points		70.0
Points to Achieve Recognition & Recieve Rewards		52.0
Points to Receive Annual Award		30.0

Measures For Both 3-Year Recognition and Rewards and Annual Rewards
Measures	Goal	Points	Frequency
HbA1c* (most recent result)	93%	10.0	Once per year
Proportion w/ HbA1c <8%	34%	5.0
Proportion w/ HbA1c >9.5%*	84%	10.0
Blood pressure frequency (most recent result)	97%	10.0	Once per year
Proportion diastolic pressure <90 mm Hg	96%	NA
Additional Required Measures For 3-Year Recognition
Measures	Goal	Points	Frequency
Eye exam *^	40%	10.0	Annual
Total Points		35.0
Points to Achieve Recognition & Recieve Rewards		26.0
Points to Receive Annual Award		18.0
Special Pediatric Age Requirement: Pediatric age range defined as 0-17 years. Pediatric patients must be 5 years of age or older, before data can be submitted as part of an application for recognition and the rewards from the DQP employer coalition.
Notes: * Consistent with Diabetes Quality Improvement Project and HEDIS measures ** Measure may be performed in the past two years, based on patient-specific criteria ^ For calculation of results for this measure, the denominator will be those patients from the applicant’s sample who have had diabetes for > 5 years

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How are patients identified for inclusion in the sample?

Applicants will select a start date and then consecutively identify eligible patients each day until the required sample size is reached. Eligible patients are those who have had diabetes for at least 12 months and who have been under the care of the applicant physician(s) for at least 12 months.

How do I receive application materials?

Visit the DPRP Web site (www.ncqa.org/dprp) or call NCQA’s Customer Support at 1-888-275-7585 to purchase application materials. Materials cost $80 and may be downloaded immediately. For the first 6 months of the Diabetes Care Link program, the employers participating in the initiative will cover the application fee for those physicians or groups that are eligible for rewards under the DCL program.

What does it cost to apply for certification or recognition?

Physicians must include the following fee with their completed application to NCQA:

For the first 6 months of the Diabetes Care Link program, the employers participating in the initiative will cover the application fee for physicians or groups that are eligible for rewards under the DCL program, regardless of whether they meet the performance measures. After the initial six months of this program, DCL may elect to discontinue this subsidy for physicians and groups that fail to receive certification or recognition.

Eligible physicians who apply as part of a group that is not eligible for rewards will receive reimbursement for the materials fee and their per physician portion of the application fee only. Eligible physicians who become certified or recognized as part of a group will receive their full individual reward amount.

How long will it take to prepare an application?

On average it will take approximately:

• 60 minutes to complete the basic application form
• 15 minutes to abstract the medical record for each patient in the sample

For example, preparation of an application package for one physician applicant with a data sample of 35 patients is approximately 10 hours (application: 1 hour; medical record abstraction: 15 minutes x 35 patients = 8.75 hours). Preparation time, however, will vary based on the administrative data systems that are available to the applicant.

Who should transcribe the data required in the application?

While the physician(s) applying may elect to do all the work, the application package (application form, medical record abstraction) can be effectively completed by other health care professionals within the practice, such as a nurse, dietitian, medical record technician, or trained clerical support staff.

How long can a physician or group of physicians maintain certification or recognition?

The annual certification and reward is valid for one year. Recognition and associated rewards are valid for three years. At the end of the annual or three-year period, a new application is required.

Processing of Applications

How long will it take for an application to be processed?

NCQA will make a decision on an application and notify the applicant within four weeks of receipt of a completed application. Incomplete applications will be returned to the applicant for completion and resubmission.

Is the data submitted confidential?

All data is confidential for both physicians and their patients. All physicians achieving certification or recognition will be promoted through DCL's Web site. In addition, recognized physicians will be promoted through the ADA and NCQA Web sites. Physicians who do not achieve certification or recognition will not be identified. Patient data is confidential and does not include patient name, address, phone number, or social security number. Instead, during data collection, physicians assign an identification number to each patient, before submitting data to NCQA.

How will NCQA/ADA know if real or accurate data has been submitted?

Random audits of applications will occur to ensure the validity of the data submitted.

Note: The DCL recognizes physicians who meet the standards of diabetes care established by the Program. Designation does not constitute an endorsement of the individual physician or a guarantee that the physician will provide quality treatment in any particular case. The DCL performance indicators and outcomes measures represent consensus standards for appropriate treatment of diabetes patients. However, they are not intended to substitute for the physician's independent judgment in treating each patient based on the individual's condition and medical history.

Certification or recognition in the one or three year program is not a guarantee of payment. The DCL may choose to add to, change or discontinue the program and/or reward payments and/or reimbursement for certification fees at any time. Neither payment of rewards nor reimbursement of fees creates an employment relationship between DCL and physicians.

Contact Us:

For information on the Diabetes Care Link visit:

http://www.bridgestoexcellence.org

For information on annual certification or triennial recognition contact NCQA at:

http://www.ncqa.org/dprp/

Customer Support @ 1-888-275-7585

For Information on Risk Adjustments contact Michael Pine & Associates at::

773-643-1700 - Joan DeSeno [email protected]

For information on Rewards contact The MEDSTAT Group at:

1-800-224-7161 or [email protected]

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