Health
Plan Licensing
In 2004 BTE entered
into its first licensing agreement with a health plan, United
Health Group. Since then, many other national and local plans
have expressed an interest in licensing BTE's programs and
implementing them in select markets, either for their fully-insured
customers or their self-insured customers. Today, BTE Licensees
and the markets in which they are implementing BTE programs
include:
Participating
Health Plans |
|
What
does Licensing BTE Programs mean for a health plan?
In licensing BTE
programs, health plans have the non-exclusive right to implement
BTE's programs for their plan members. They do not have the
right to implement BTE's programs for non-plan members. Non-plan
members can participate in BTE's programs either through another
health plan licensee (if available in that market) or through
BTE directly.
The licensing
agreement also authorizes the plan to use the BTE brand
and associated registered trademarks in promoting and implementing
the programs locally. In exchange for these rights a health
plan is required to execute a Licensing Agreement and pay
a modest licensing fee.
Does
a health plan have to implement all BTE programs?
Health plans have
the right, in collaboration with their customers and other
BTE participants in the market, to select the programs they
wish to implement. They are asked to actively cooperate with
other BTE Licensees or Participants in any market to ensure
that the Programs' impact will be as significant as possible.
Plan Licensees
also have the right and flexibility to incorporate BTE's programs
as part of their existing pay-for-performance programs, and
to modify the recommended bonus amounts to reflect any rewards
they have already built in their current pay-for-performance
programs.
What
are the obligations of Plan Licensees?
There are only
a handful of obligations for plan licensees. These include:
- Rewards paid
by the Licensee have to be meaningful and positive, not
simply punitive, and aimed at achieving a positive sum outcome
for BTE program participants
- Rewards should
be paid after physicians have demonstrated high performance
- Plan members
should be encouraged to seek out recognized providers and
plans should create incentives for better member self-care
- Licensee should
use independent national accrediting organization to assess
and recognize provider performance community-wide
- Licensee should
continue pushing for ever-tougher standards on provider
performance and demand complete accountability for use of
resources and delivery of outcomes
- Within the limits
of applicable law, Licensee should participate in cross-learnings
with other BTE participants and Licensees on the results
of the program
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