BUSINESS, GOVERNMENT & INDUSTRY EMBRACE COMMON STRATEGY
TO IMPROVE HEALTH CARE: PAY-FOR-PERFORMANCE
- The Bridges to Excellence
(BTE) Coalition today announced a series of major new pay-for-performance
(P4P) initiatives involving the Medicare program, various
business coalitions, a large national plan and an important
regional BlueCross BlueShield plan. Together these initiatives
cover more than 10 states and involve well over 2 million
people. More than 80 other pay-for-performance efforts are
currently underway nationwide. Mounting evidence that pay-for-performance
drives improvement has made it a popular approach to health
care reform, a significant departure from two years ago
when the Bridges to Excellence coalition was getting started.
BTE's pay-for-performance efforts build off of physician
recognition programs designed by the National Committee
for Quality Assurance (NCQA) and its partners, the American
Diabetes Association (ADA) and the American Heart Association/American
Stroke Association. The three P4P programs under Bridges
to Excellence are Diabetes Care Link, Cardiac Care Link
and Physician Office Link.
is growing for pay-for-performance initiatives in all regions
of the country," said BTE President and Verizon Regional
Healthcare Manager Jeff Hanson. "Bringing government,
industry, physicians and businesses together around quality
health care issues and holding the health care industry
to the highest standards of excellence will benefit all
Margaret E. O'Kane,
President of NCQA, echoed that sentiment. "It's a concept
that sells itself - pay good doctors more and encourage
employees to go see those doctors so they get better faster.
The rewards for both patients and doctors are right there
on the surface."
The Centers for
Medicare & Medicaid Services (CMS) is currently developing
a number of pay-for-performance programs. Its strong support
of the concept is among the biggest factors driving acceptance
of P4P, as is evidenced from several early programs that
the strategy drives meaningful improvements.
participating in the longstanding NCQA/ADA Diabetes Physician
Recognition Program (DPRP) (the foundation of one BTE P4P
program - Diabetes Care Link), performance on a range of
clinical measures has improved 50% or more over the past
independent studies done by three national health plans
found that physicians participating in the BTE Diabetes
Care Link program offered care that was substantially more
consistent with best practice guidelines. These physicians
also delivered care at a 10% to 15% lower cost than non-DPRP
recognized physicians. The majority of the savings come
from fewer hospitalizations and fewer patient visits to
the emergency room.
CMS is also looking towards the BTE Physician Office Link
program as a possible element in its forthcoming Medicare
Care Management Performance Demonstration project, an initiative
which will promote the adoption and use of health information
technology to improve the efficiency and quality of patient
care for chronically ill Medicare patients. Doctors who
meet or exceed performance standards established by CMS
in clinical delivery systems and patient outcomes will receive
performance payments for managing the care of eligible Medicare
The effort, scheduled
to begin later this year, will involve hundreds of doctors
in medical practices in Arkansas, California, Utah and Massachusetts.
In many of these States, CMS will collaborate with BTE and
other private pay-for-performance initiatives.
100 percent committed to promoting pay-for-performance,"
said Mark McClellan, M.D., Ph.D., CMS Administrator. "Engaging
patients, improving evidence based care and efficiencies,
controlling costs, promoting the use of information technology,
broad performance measurement and reporting - pay-for-performance
will help make all of these a reality."
The BTE effort
establishes a direct link between pay-for-performance and
the adoption of information technology, by rewarding physicians
who make related investments--a strategy that has won praise
from the nation's chief health care information technology
advocate, David Brailer, M.D., Ph.D., National Coordinator
for Health Information Technology. "Pay-for-performance
initiatives, such as these, will help reduce economic barriers
to the adoption of electronic health records," said
Brailer. "Electronic health records will in turn, help
physicians improve quality and patient safety."
This year's report
by the Medicare Payment Advisory Commission recommends that
CMS widen its pay-for-performance efforts and focus on encouraging
adoption and use of health information technology, as exemplified
by the BTE Physician Office Link program.
Physicians Applaud Effort
The American Academy of Family Physicians (AAFP) has long
encouraged its members to adopt information technology and
add quality improvement efforts to their practices.
is tangible evidence that physicians who install systems
for better care may be rewarded, said Mary Frank, M.D.,
President of the American Academy of Family Physicians.
"The AAFP supports pay-for-performance programs that
engage the patient and provide positive incentives for physicians.
The BTE program has a clear focus on office process improvement,
not just outcomes of care. We look forward to working with
the BTE Coalition in the future."
The four coalitions launching BTE-related projects are located
in Illinois (two in Illinois), Colorado and Arkansas. The
coalitions, through a licensing arrangement with BTE, have
begun talking with employers and estimate launching customized
programs in their respective markets later this year. Business
coalitions are well suited to coordinating such incentive
programs - by coordinating activities among employers, they
can pool resources and streamline related operations, thus
making the efforts more attractive to employers and physicians.
All four coalitions are members of the National Business
Coalition on Health (NBCH), a 70-coalition member strong
organization that strongly supports pay-for-performance.
the early part of a gold rush here where everyone's experimenting
with pay-for-performance in health care," said Andrew
Webber, president and CEO of NBCH. Our focus now is on operationalizing
the process in different settings and at different levels
of the system."
Healthcare, CIGNA & CareFirst BlueCross BlueShield
Last July, United Healthcare became the first health care
company to license the BTE model, working with employers
in Omaha, St Louis, Dayton and South Florida to offer network
doctors certain incentives for earning NCQA recognition.
"BTE is a wonderful way to recognize and reward physicians
for following evidenced based-guidelines and adopting recognized
best practices," said Vince Kerr, M.D., President,
Care Solutions, United Healthcare. "It also allows
patients who are making care decisions to factor that important
information into their decisions. It's a win for both doctor
and patient. I think that explains some of the excitement
we are seeing in markets where this is being launched."
BlueShield recently became the second health plan to license
BTE, and the first to fund provider incentives itself. Carefirst
BlueCross BlueShield will pay up to $50 per patient to reward
physicians who meet NCQA's Physician Practice Connections
criteria (which promotes the use of information technology
to improve safety and standardize care). A not-for-profit
health plan serving 3.2 million members in Maryland, Virginia
and the District of Columbia, CareFirst BlueCross BlueShield
will also reimburse physicians for the costs associated
with pursuing NCQA recognition. CareFirst's BlueCross BlueShield
demonstration project will cover 16,000 CareFirst BlueCross
where obligation and opportunity meet," CareFirst BlueCross
BlueShield President and CEO William L. Jews. "Every
health plan has an obligation to deliver the best possible
care and service. Through BTE, we have the opportunity to
meet that obligation in a way that benefits both our patients
and our physicians. Doctors get financial support for upgrading
their systems and patients get more information to help
make health care decisions."
is the latest plan to license the Bridges to Excellence
program and is working with employers to pursue a pay-for-performance
effort in Phoenix and North Carolina and may expand to other
markets as well.
our current high performance network efforts (CIGNA Care
Network) to include the NCQA Physician Recognition
programs and a pay-for-performance program strengthens the
depth and breadth of the information we provide to our members
while rewarding physicians for high quality care,"
added Jeff Kang, M.D., Chief Medical Officer for CIGNA HealthCare.
Bridges to Excellence
The Bridges to Excellence coalition is a not-for-profit
organization created to encourage significant leaps in the
quality of care by recognizing and rewarding health care
providers who demonstrate that they deliver safe, timely,
effective, efficient and patient-centered care. In addition
to NBCH, Bridges to Excellence participants include large
employers, health plans, the National Committee for Quality
Assurance, MEDSTAT and WebMD Health, among others. The organizations
are united in their shared goal of improving health care
quality through measurement, reporting, rewards and education.
Additional information is available at www.bridgestoexcellence.org.