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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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