Blue Cross Blue Shield of North Carolina is committed to ensuring
the delivery of quality services to members and is the first
health plan in NC to implement Bridges to Excellence. This
3-year pilot of a provider reward and recognition program
is one of several initiatives to test ways to improve health
outcomes and affordability for members.
There are many opportunities for improvement in how our nation's
health care system recognizes and rewards clinical excellence.
The Bridges to Excellence pilot will create new financial
incentives to improve care by recognizing and rewarding qualifying
physicians for taking concrete, measurable steps to further
improve health outcomes for their patients.
To extend the reach of this important quality initiative,
the BTE pilot was launched in conjunction with the North Carolina
State Health Plan. The State Health Plan also desires to see
the highest quality of care delivered in North Carolina for
its members (www.statehealthplan.state.nc.us). BCBSNC and
the State Health Plan will fund the pool of BTE rewards.
All ASO and insured commercial BCBSNC members, under age
65, and State Health Plan members, that are treated by physicians
participating in the pilot will count towards rewards.
All primary care physicians, endocrinologists and cardiologists
contracting with BCBSNC were invited to apply for participation
in this pilot. Physicians with about 40,000 BCBSNC and SHP
members will be selected for the pilot. From those who apply,
selection is made on the basis of geography, specialty, practice
size and other factors.
Participating physicians earning one or more of three NCQA
Recognition Programs will automatically earn BTE financial
rewards paid by BCBSNC and the SHP. These rewards are in addition
to normal fee reimbursements. They will also be recognized
in BCBSNC's provider directory. BCBSNC will provide on-site
and telephonic assistance to these physicians, as well as
making it possible for them to participate in an electronic
prescribing initiative for a year at no charge (e-Prescribe).
Finally, physicians earning NCQA Recognition will be reimbursed
for the fees they have paid to NCQA.
For more information about BCBSNC's BTE implementation, please
download this
press release (82kb MS Word document).
Program Participation:
Physician Office Link Program (POL), Diabetes Physician
Recognition Program (DPRP), Cardiac Care Link Program (CCL)
*Learn
more about how to become an NCQA Recognized Physician*
Physician
Office Link Program (POL)
The POL program is designed to promote and reward office practices
for the use of systematic information to enhance the quality
of patient care.
Systematic processes have been shown to contribute to improvements
in health care, including physicians' ability to monitor their
patients' medical histories and their ability to follow up
with their patients and with other providers. Physicians earning
the NCQA Physician Practice Connection Recognition Program
will earn BTE rewards each year (see below) for each BCBSNC
and SHP member with a claim during a recent 12-month period.
Diabetes Care Link Program (DCL)
The DCL program is focused on improving the quality of care
for patients with diabetes. Physicians earning the NCQA Diabetes
Physician Recognition Program can earn rewards (see below)
each year for BCBSNC and SHP members treated for diabetes
during a recent 12-month period.
Cardiac Care Link Program (CCL)
The CCL program is focused on improving the quality of care
for patients with cardiovascular disease. Physicians who demonstrate
they are top performers in cardiac care can earn rewards (see
below) each year for BCBSNC and SHP members treated for cardiovascular
disease during a recent 12-month period.
Pilot
Reward Opportunities
|
. |
POL |
DCL |
CCL |
|
YEAR |
Basic per member ($) |
Intermediate
per member ($) |
Advanced
per member ($) |
Basic
per DCL member ($) |
Basic
per CCL member ($) |
Advanced
per CCL member ($) |
|
1 |
20 |
30 |
50 |
70 |
70 |
120 |
| 2 |
15 |
30 |
50 |
70 |
60 |
120 |
| 3 |
10 |
30 |
50 |
70 |
50 |
120 |
| Annual
Caps |
15k/physician 90k/location |
20k/physician
120k/location |
25k/physician
150k/location |
15k/physician
90k/location |
15k/physician
90k/location |
25k/physician
150k/location |
| Overall
Cap |
$60,000
per physician for the entire three-year Pilot for all
programs combined. |
Back
to Top
| |
|
Blue Cross Blue Shield of North Carolina |
| Regional
Contact(s) |
Title |
Company |
Contact
Information |
| Steve
Clayton |
Director |
BCBSNC |
[email protected] |
*For
information regarding Health Plan Licensing please
click here.
About
BCBSNC:
Blue Cross and Blue Shield of North Carolina is a leader in
delivering innovative health care products, services and information
to more than 3.3 million members, including approximately
639,000 served on behalf of other Blue Plans. For 72 years,
the company has served its customers by offering health insurance
at a competitive price and has served the people of North
Carolina through support of community organizations, programs
and events that promote good health. Blue Cross and Blue Shield
of North Carolina is an independent licensee of the Blue Cross
and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.
|
Recognized Practices |
Recognized
Physicians |
Rewards
Paid |
| NA |
|
NA |
Back
to Top
NORTH CAROLINA NEWS
Coming Soon!
Back
to Top
