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
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.
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.
out the Diabetes
Care Analysis - Savings Estimate (PDF)
Diabetes Care Performance Assessment Program
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.
performance assessment options are available through NCQA:
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.
is NCQA's performance assessment program?
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
obtain 1-year certification and rewards, physicians submit
data on outcome measures for their diabetes patients.
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.
DPRP applicants from 1997 to 2003:
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
rate of diabetes patients who had controlled low-density
lipoprotein (LDL) cholesterol below 100 mg/dl rose from
17 percent to 45 percent.
rate of diabetes patients monitored for kidney disease
rose from 60 percent to 85 percent. Data source: NCQA
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
measures will be used to determine eligibility for recognition?
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.
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
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
- 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
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.
to apply to NCQA
is the application process for NCQA's performance assessment
- Go to www.ncqa.org/dprp
to review DPRP information and request an application
- 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
- Decide whether
to apply for 1-year
certification or 3-year recognition
- Submit to
NCQA the following:
- A completed
- A signed DPRP
- A signed Business
- A completed
Survey Tool and DPRP Medical Record abstraction worksheet
- Any remaining
fee due for an application for a group of physicians.
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.
does it cost to apply for certification or recognition?
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.
surcharge for every MD >200)
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.
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.
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.
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.
can apply for group recognition with some of all of the physicians
at the practice site and/or for individual recognition.
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.
Bridges to Excellence reimburse fees paid to NCQA for performance
Practices may be eligible for reimbursement of NCQA program
(reimbursement up to 1 NCQA physician fee paid per 10 DCL/CCL
patients or 50 POL patients).
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 NCQAs 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
there a deadline or required date for submitting data to NCQA
for performance assessment?
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.
long will it take to prepare an application?
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
long will it take for NCQA to process an application?
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
will NCQA know if accurate data has been submitted?
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.
the data submitted confidential?
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").
long can a physician or group maintain recognition with NCQA?
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.