The Minnesota market has several existing building blocks that have expedited the implementation of BtE for diabetes.

  • Pay for performance programs for diabetes care have been in place for several years in the MN market
  • The Institute for Clinical Systems Improvement,, has been in existence since 1993, developing clinical guidelines, providing support for their implementation and developing measures for performance evaluation with a broad range of community physicians
  • Minnesota Community Measurement,, was formed in 2002 by several local health plans to collaborate on collecting performance data and publicly report the results on community physicians

As BHCAG proceeded with BtE, it formed a Guiding Coalition comprised of multiple community stakeholders including representatives from 4 of the market’s largest health plans, its QIO, several large employers, providers, ICSI, and MN Community Measurement. Its purpose was, and is, to guide the design, development, implementation and ongoing strategy for BtE in Minnesota.

The Guiding Coalition recommended rewarding medical groups rather than individual physicians due to the configuration of most physician practices in Minnesota and because this was the unit of measurement for MN Community Measurement. They also recommended using ICSI’s measure for quality diabetes as the standard. ICSI recommends a composite measure called “Optimal Diabetes Care,” and requires all 5 clinical indicators below be met for each patient in order to count towards their score:

  • HbgA1c < 7
  • LDL < 100
  • BP < 130/80
  • Non-smoking status
  • Aspirin for patients over 40

An extremely valuable by-product of the Guiding Coalition’s work was achieving consensus among the health plans to use the same composite measure for all their diabetes pay for performance programs. Going forward, the Guiding Coalition will strive for alignment across payers in all their pay for performance programs.

They also recommended that MN Community Measurement perform the quality review and public reporting functions. MN Community Measurement routinely reviews and reports on the performance of 54 Minnesota based medical groups each year by combining data from seven health plans with information from chart abstraction. The Guiding Coalition recommended that groups with at least 10% of their diabetic patients at the Optimal Diabetes Care standard be rewarded in 2006.

Participation: Diabetes Care Link (DCL)

Diabetes Care Link Program(DCL)

The DCL program is focused on improving the quality of care for patients with diabetes. Physicians meeting the thresholds established by the Minnesota Guiding Coalitions earn rewards. The chart above is typical of the publicly reported information available at It compares performance for Minnesota medical groups on the “Optimal Diabetes Measure.” The top nine groups will be rewarded in 2006 and will be paid $100 for each diabetic patient covered by each of the participating employers. These rewards are in addition to normal fee reimbursements from the employers’ self-funded health plan. In 2007 and beyond, the Guiding Coalition will raise the threshold each year to a goal that is achievable, based on past performance, yet challenging.


BHCAG, MN Community Measurement, Medstat


Regional Contact(s)
Contact Information
Linda Davis
Consulting Director
LCD Solutions Ltd.

[email protected]



The Buyers Health Care Actions Group (BHCAG),, formed in 1991 is a large employer business coalition in Minnesota that has been a catalyst for many market reform initiatives including the formation of ICSI, Patient Choice, a consumer oriented health plan, supporting the Leapfrog Group efforts, the National Business Coalition on Health (NBCH)’s Evalu8, the Smart Buy Alliance, a public/private consortium of purchasers committed to value based purchasing and, now, Bridges to Excellence.

  • 3M
  • Alliant
  • Allina
  • AMS
  • Barry Wehmiller
  • Berlex
  • Cargill
  • Carlson Companies
  • Ceridian
  • ELCA
  • General Mills
  • Glaxo Smith Kline
  • Honeywell
  • Johnson & Johnson
  • Jostens
  • Land O’ Lakes
  • Medtronic
  • Merck & Co.
  • Minnesota Life
  • Olmsted County
  • Park Nicollet
  • Resource Training and Solutions
  • Rosemount
  • St. Jude
  • Target
  • Tennant
  • TCF Financial
  • University of Minnesota
  • US Bank
  • Wells Fargo

BHCAG is committed to reforming the delivery health care. This provider reward and recognition program is one of its several initiatives in Minnesota which is aimed at creating a tipping point for physicians to re-engineer care processes and providing incentives to improve health and health care rather than just deliver more services.


Coming Soon!

Back to Top