Diabetes Care Link (DCL)

*Please note that some of the information below could be specific to a region, for example reward amounts and/or fee reimbursement. For market specifics, please contact your local BTE administrator.

The DCL program is intended to improve the quality of care for patients with diabetes.

  • Patients who use disease management tools to self-manage their own diabetes care can earn rewards for achieving target goals that improve their health.
  • Physicians who demonstrate they are top performers in diabetes care can earn up to $80 per year for each diabetes patient covered by a participating employer.

Check out the Diabetes Care Analysis - Savings Estimate (PDF)

NCQA Diabetes Care Performance Assessment Program

To obtain the rewards available through the Bridges to Excellence Diabetes Care Link (DCL) reward program, eligible physicians must demonstrate that they provide high levels of diabetes care by passing NCQA's diabetes performance assessment program.

Two performance assessment options are available through NCQA:

  • For 1-year certification for BTE rewards-eligible physicians, physicians submit data on HbA1c, blood pressure, and lipid testing for their diabetes patients.
  • For 3-year recognition from NCQA's Diabetes Physician Recognition Program (DPRP), physicians submit data on the same three outcome measures as needed for 1-year certification, as well as data on eye, foot, and nephropathy exams for their diabetes patients.

What is NCQA's performance assessment program?

The National Committee for Quality Assurance (NCQA) is the leading independent organization providing information that allows employers and consumers of health care to distinguish among health plans and physicians based on quality of care. The American Diabetes Association (ADA) and NCQA have developed the Diabetes Physician Recognition Program (DPRP) to assess physician performance in the care of patients with diabetes, and to recognize those physicians who demonstrate a high level of performance.

To achieve DPRP Recognition, physicians submit data on outcome and process measures for a sample of their patients with diabetes. The Bridges to Excellence (BTE) Diabetes Care Link (DCL) program will reward DPRP-Recognized physicians, as well as physicians who successfully seek an alternative 1-year certification for diabetes care that NCQA administers for BTE. To obtain 1-year certification and rewards, physicians submit data on outcome measures for their diabetes patients.

Does obtaining recognition improve the quality of health care?

Yes, as seen in DPRP historical results, we believe that if physicians 1) know what processes and outcomes are essential, and 2) collect data on what they do and are able to review aggregate data from their patient population, care will improve.

For DPRP applicants from 1997 to 2003:

    • The average rate of diabetes patients who had Hemoglobin A1c (HbA1c) levels of less than 7 percent increased from 25 percent to 46 percent, an indication that more adults with diabetes are maintaining proper HbA1c control. HbA1c is a measure of average blood sugar over the previous three months.
    • The rate of diabetes patients who had controlled low-density lipoprotein (LDL) cholesterol below 100 mg/dl rose from 17 percent to 45 percent.
    • The rate of diabetes patients monitored for kidney disease rose from 60 percent to 85 percent. Data source: NCQA

How will the public know which physicians have obtained recognition?

All BTE rewards-eligible practices and physicians who obtain recognition with NCQA's Diabetes Physician Recognition Program (DPRP) will be promoted as recognized practices and physicians through NCQA's web site. BTE rewards are available to those who achieve a 1-year certification; BTE will list physicians with a 1-year certification on the Physician Quality Ratings web site and NCQA will provide a certificate to those who are certified. To identify the physicians in your area who demonstrate a high level of performance in providing care, click on the DPRP directory on NCQA's Recognized Physician Search page. Practices that submit an application but do not achieve recognition are not publicly identified.

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NCQA Measures

What measures will be used to determine eligibility for recognition?

Three-year DPRP recognition from ADA/NCQA requires submission of process and outcomes measures. To receive one-year certification, physicians must submit data on HbA1c, blood pressure, and lipid testing. For specific measures visit NCQA.

Physicians who believe they treat sicker patients may request to that their patients' clinical data be risk-adjusted. Risk-adjustment is available for the annual certification, but is not available for the three-year ADA/NCQA recognition.

In addition to the data required to apply for certification, risk adjustment will require the following information:

  • Patient age, gender, height, and weight
  • HemoglobinA1C, blood pressure, lipid profile, creatinine or BUN, hemoglobin or hematocrit values for dates of service PRIOR to the dates submitted in the patient sample data for certification or recognition
  • Types of treatment being received by patients in the sample (i.e., insulin, oral hypoglycemics, antihypertensives, lipid lowering agents, renal dialysis)
  • ICD-9-CM diagnosis codes.

Physicians may request risk adjustment for the annual certification, based on the required sample of 35 patients. For a more complete assessment of risk, physicians may also submit data for additional patients. Physicians who wish to have their patient data risk-adjusted may contact Joan DeSeno at Michael Pine and Associates, Inc., for forms, software and assistance in accessing their data in the most efficient manner possible. Ms. DeSeno can be reached by phone at 773-643-1700, by fax at 773-643-6601, or by e-mail at [email protected]. Additional information is available regarding the Rationale and Methods for Risk-Adjusting Diabetic Outcomes.

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How to apply to NCQA

What is the application process for NCQA's performance assessment program?

  1. Go to www.ncqa.org/dprp to review DPRP information and request an application packet.
  2. Purchase a user license for DPRP through NCQA's Interactive Survey System (ISS). The ISS allows applicant physicians to download an Excel worksheet so that they may complete a self-scoring readiness evaluation.
  3. Decide whether to apply for 1-year certification or 3-year recognition
  4. Submit to NCQA the following:
  • A completed DPRP application
  • A signed DPRP agreement
  • A signed Business Associate addendum
  • A completed Survey Tool and DPRP Medical Record abstraction worksheet
  • Any remaining fee due for an application for a group of physicians.

How do I receive application materials from NCQA?

Visit NCQA's DPRP web site (www.ncqa.org/dprp) or call NCQA's Customer Support at 1-888-275-7585 to request an application packet.

What does it cost to apply for certification or recognition?

Physicians and physician groups seeking recognition pay the following fees:

Under the new pricing methodology, released June 1, 2005, fee schedule amounts - as shown below - are the same as they were previously; however, the schedule is now applied to all of the doctors within a physician group applying for recognition. This is in contrast to before, when the fee schedule applied to each separate medical practice site, generating significant costs to purchase the survey tool and very high total application fees. This change to the pricing methodology does not affect the current HSRP sampling methodology.

Survey Tool Price: $60 each (1 per site)
Number of Physicians
Fee Schedule
Discount Fees
1 $450 $360
2 $900 $720
3 $1,350 $1,080
4 $1,800 $1,440
5 $2,250 $1,800
6 $2,700 CAP $2,160
7 $2,700 $2,700 CAP
Over 7 $2,700 $2,700

($5 surcharge for every MD >200)

The fee schedule includes the price of one (1) survey tool and applies to all physicians in a group (e.g., medical practice, group of practices or corporate entity) and one (1) tool per site is required.

The discounted fee schedule pertains to sponsored medical groups only (e.g., BTE, health plans, etc.); it does not apply to multi-site or multi-program applications.

Note: A practice group has twelve (12) months from its first decision/recognition date to complete the application process for all sites in its group under the fee schedule at the time of initial submittal. After that year ends, the applicant must start over with the sliding fee schedule in effect at that time.

These fees include access to NCQA's Web-enabled platform, all materials and the recognition application fee. Please visit the NCQA web site for up to date NCQA fee information.

Physicians can apply for group recognition with some of all of the physicians at the practice site and/or for individual recognition.

A volume discount for health plans that wish to sponsor more than ten physicians for recognition may be available by contacting the NCQA at [email protected]. Physicians who already have achieved Recognition in one of the NCQA Performance Assessment programs may obtain a 20% discount if they wish to apply for Recognition under an additional NCQA Program. Please contact NCQA Customer Support at 1-888-275-7585.

Will Bridges to Excellence reimburse fees paid to NCQA for performance assessment?

Practices may be eligible for reimbursement of NCQA program fees paid
(reimbursement up to 1 NCQA physician fee paid per 10 DCL/CCL patients or 50 POL patients).

Physicians applying for performance assessment must pay fees established by NCQA for administering the DPRP program. Physicians who pass NCQA's performance criteria will be reimbursed by Bridges to Excellence for 1 NCQA applicant fee per 10 DCL patients.

For example, a group with 5 physicians and 38 qualifying DCL patients applies to NCQA for the DPRP program, paying $1,800 in application fees. The practice passes NCQA’s performance criteria and is eligible for rewards through Bridges to Excellence. With 5 physicians, the practice paid an average NCQA fee of $360 per applicants ($1,800/5 = $360). With 38 qualifying DCL patients, the practice qualifies for 3 applicant fee reimbursements (38/10 = 3). The practice will be reimbursed by Bridges to Excellence a total of $1,080 ($360 x 3 = $1,080) for applicant fees paid to NCQA.

Is there a deadline or required date for submitting data to NCQA for performance assessment?

You may submit your performance data to NCQA at any time during the year. After passing NCQA's performance criteria, Bridges to Excellence will pay the full annual reward amount during the quarter after a physician or physician group achieves HSRP Recognition. To receive Bridges to Excellence rewards certain deadlines may apply. Please call 1-800-224-7161.

How long will it take to prepare an application?

Applicants should anticipate that it will require 1 - 3 months to identify eligible patients, abstract data for these patients from medical records and/or administrative systems, enter data into the self-assessment worksheet and submit all completed materials and their application to NCQA.

How long will it take for NCQA to process an application?

NCQA will make a decision on an application and notify the applicant within 28 days of receipt of application fees, a completed application packet and submission of responses and supporting documents in the Interactive Survey System. Application documents and data include the Application (with physician background information), Agreement, Business Associate addendum and DPRP Medical Record Abstraction Worksheet.

How will NCQA know if accurate data has been submitted?

Random audits of applications will occur to ensure the validity of applicant data. DPRP audits are generally conducted by mail, but may also result in onsite review.

Is the data submitted confidential?

All data is confidential for both physicians and their patients. All physicians achieving annual certification or DPRP Recognition will be promoted through the Bridges to Excellence web site. In addition, DPRP-Recognized physicians will be promoted through the ADA and NCQA web sites. Physicians who do not achieve certification or recognition will not be identified. Patient data is confidential and does not include patient name, address, phone number, or social security number. Instead, during data collection, physicians assign an identification number to each patient, before submitting data to NCQA. To further protect applicants, applicants and NCQA will execute a business associate addendum to ensure compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").

How long can a physician or group maintain recognition with NCQA?

DPRP Recognition and associated rewards through the Bridges to Excellence DCL program are valid for three years. Certification and associated rewards through the Bridges to Excellence DCL program are valid for one year. At the end of the three-year or annual period, a new application is required.


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