BTE Overview

What is "Bridges to Excellence"?

Bridges to Excellence is a multi-state, multiple employer initiative designed to reward quality across the healthcare system, 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.

What organizations participate in Bridges to Excellence?

Participating organizations include NCQA among its charter members and a diverse coalition of physicians, health plans, quality experts and consultants advance the pay-for-quality concept. Charter employers include General Electric, UPS, Procter & Gamble and Verizon, all of which offer bonus payments to physicians who deliver high-quality care to their employees.

What organizations administer the program and what are their respective roles?

The National Committee for Quality Assurance (NCQA) selects which physicians qualify for awards based on evaluating and verifying their data. NCQA is the leading independent organization providing information that allows purchasers and consumers of health care to distinguish among health plans and physicians based on quality of care.
MEDSTAT acts as overall program manager and is in charge of distributing bonus payments.

Michael Pine and Associates in the Diabetes Care Link and Cardiac Care Link programs, helps participating physicians risk adjust their data to account for the relative health of the patients they treat.

In addition, Partners Community Healthcare, Inc., the Lahey Clinic and the Cincinnati Children’s Hospital Medical Center, all among the nation’s most highly regarded medical institutions, played important roles in shaping the initiative.
Who is eligible for Bridges to Excellence?

Physicians who treat employees or covered family members of the participating employers may receive bonus payments and recognition under the initiative.

I am interested in learning more about the metrics involved in STEEEP.  For example, how does Bridges to Excellence define and measure "S- Safety, T- Timely, E- Effective"...etc., and how is this information reported?

The definition of STEEEP is included in the IOM's report, Crossing the Quality Chasm, which we have referenced in the literature/reference list. The report has a full description of what each concept represents. We believe we're impacting all of these through the combinations of our programs and the measurement of provider performance against POL, DCL, CCL and the patient experience of care. In fact, the programs were designed using the STEEEP criteria as "CTQs". One example would be the e-prescribing and e-ordering module in PPC as helping to significantly decrease drug-related errors and improving the safety of patient care. Another example is the measurement of clinical outcomes for patients with diabetes or cardiac disease as having a very significant impact on the effectiveness of care. Finally, the patient experience of care survey that we are collecting and reporting impacts the patient-centeredness of care.

What is the relationship between HealthGrades and Bridges to Excellence?

HealthGrades supports the Bridges to Excellence Program by building and maintaining the Physician Quality Ratings and Physician Practice Portal Websites. This includes gathering and scoring patient satisfaction data through Bridges to Excellence surveys and allowing practices to self identify through a single national portal.

Does Bridges to Excellence use any HealthGrades data?

No, data comes from Bridges to Excellence's other partners such as Medstat and The National Committee for Quality Assurance (NCQA). HealthGrades builds, hosts, and maintains the Physician Quality Ratings Website.

What is Data Processing Engine & Repository (DPER)/BTE Recognition Data Exchange (RDE)/BTE Operations (BTE Ops)?

BTE Recognition Data Exchange facilitates coordinated automated market wide BTE Operations for all stakeholders by:

1. Providing different modes of operating the program in a market.
2. Providing appropriate level of coordination.
3. Allowing for the potential of multiple Performance Assessment Organizations in a single market.
4. Connecting as a single entry point to the Physician Portal in order to share the Practices composition information for rewards.
5. Providing systematic platform to display provider quality ratings to plan members/employees.

Diabetes Care Link

Why is Bridges to Excellence targeting diabetes?

According to the American Diabetes Association, more than 17 million Americans suffer from diabetes, ranking it among the nation’s most serious health issues. Employees suffering from poorly controlled diabetes typically miss about 12 days of work per year due to the illness, as compared to just two days for diabetics whose illness is well controlled.

How do I find physicians participating in this program?

All physicians achieving certification or recognition will be promoted through the Diabetes CareRewards website. If you find a physician from whom you wish to seek services, be sure to check with your health plan to verify that the physician is covered within your network.

What do physicians need to do to qualify for bonus payments?

To qualify for bonus payments, physicians will measure the percentage of their diabetic patients whose blood pressure, blood sugar and lipid levels are sufficiently measured and controlled. The performance measures for Diabetes Care Link are based on those used in the American Diabetes Association/NCQA
Diabetes Physician Recognition Program (DPRP).
Aggregate performance results indicate that DPRP-recognized physicians provide quality care and have improved care delivery between 1997 and 2001:
  • The average rate of diabetes patients who had Hemoglobin A1c (HbA1c) levels of less than 8 percent increased from 50 percent to 70 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 properly controlled low-density lipoprotein (LDL) cholesterol gained 35 percentage points (37 percent to 72 percent).
  • The rate of diabetes patients monitored for kidney disease rose from 60 percent to 84 percent.

What is Diabetes CareRewards?

Diabetes CareRewards is an online program specifically designed for patients diagnosed with diabetes. Industry research has shown that people with diabetes are concerned about eating well, minimizing stress, staying active, and finding resources to manage their condition. Diabetes CareRewards provides online personalized support and incentives to help you achieve an optimal level of diabetes health. This new resource promotes the achievement of target diabetes goals to improve your health and prevent diabetes complications. By working to optimally manage your diabetes, you'll be eligible to earn points via CareRewards

Who sponsors the Diabetes CareRewards program?

A powerful coalition of employers and health plans has joined together to promote the achievement of target diabetes goals to improve the quality of diabetes care and prevent diabetes complications

What is the value of the bonus payments?

Physicians meeting the necessary thresholds will receive a yearly bonus of $80 for each of their diabetic patients covered by one of the participating employers. For example, a physician who treats 150 diabetic employees or family members would receive a $12,000 year-end bonus.

What is the difference between a certified and a non-certified doctor?

A certified physician has demonstrated good outcomes in the management of patients with diabetes. Good outcomes in diabetes care is achieved by successfully completing the requirements for certification or recognition of the Diabetes Physician Recognition Program (DPRP) administered by the National Committee for Quality Assurance (NCQA) and sponsored by the American Diabetes Association (ADA).

Do I have to change physicians to participate?

No. You do not have to change doctors to be eligible to use the Diabetes CareRewards website or participate in the Diabetes CareRewards program.

Are there any other facets to Diabetes Care Link?

Yes. Diabetes Care Link will also include a reward program to encourage employees and family members to take a more active role in managing their condition. In addition, patients with diabetes will be eligible for tools, support and information. By using these tools, they may receive incentives such as cash, discounted co-payments or other rewards.

Where is Diabetes Care Link being piloted?

Diabetes Care Link completed its pilot in Cincinnati, Ohio and Louisville, KY on December 31, 2005. It is currently being piloted in Massachusetts & Capital NY Region (Albany-Schenectady-Troy).

With healthcare costs rising, how can Diabetes CareRewards be offered to me?

When a patient and physician work together for better health, costs go down for everyone.

Cardiac Care Link

Why is Bridges to Excellence targeting cardiovascular care?

According to the American Heart Association/American Stroke Association, more than 60 million Americans have one or more types of cardiovascular disease. It is the leading cause of death in the United States.

What do physicians need to do to qualify for bonus payments, when available?

Cardiac Care Link is similar to Diabetes Care Link in that it will ask physicians to measure their performance in key areas of care. Physicians who meet the necessary thresholds will receive financial incentives for each of their cardiovascular patients covered by one of the participating employers. Final measures for Cardiac Care Link were released in 2003; they are based on those used in the Heart/Stroke Recognition Program (HSRP) developed by the American Heart Association/American Stroke Association and NCQA.

Physician Office Link

Why is Bridges to Excellence targeting office systems?
Systematic processes contribute to improvements in health care. Physicians who use systematic processes are better able to:
  • Monitor their patients' medical histories
  • Work with patients over time, not just during office visits
  • Follow up with patients and with other providers
  • Manage populations, not just individuals, using evidence-based care
  • Encourage better health habits and self-management of medical conditions.
  • Avoid medical errors
What standards are in Physician Office Link?

NCQA has developed Physician Practice Connections (PPC), the performance assessment for the Bridges to Excellence rewards program, Physician Office Link. PPC assesses office practices' performance in the areas of clinical information systems, patient education and support and care management.

Meeting PPC standards means that practices have connections--to information, to patients, to other practitioners, to evidence. The connections in PPC take several forms, and NCQA evaluates three overlapping categories of standards:
Clinical Information Systems/Evidence-Based Medicine:
How does the practice use information to keep track of patients' treatments, follow up on tests, check medications and use researched standards of care?

Patient Education and Support:

How does the practice use resources and referrals to help patients manage their own health? How does the practice measure and improve quality?

Care Management:

How does the practice actively help patients with chronic conditions and patients with very complex problems maximize their health and prevent hospitalization?
What do physician practices need to do to qualify for bonus payments?
To pass NCQA's Physician Practice Connections program, practices must submit data in any one of the three performance areas above. To qualify for full Physician Office Link rewards, practices must submit data and obtain a three-year recognition in each of the three performance areas.

Which episodes of care are included in the POL evaluation? Are they the same episodes used in evaluating DCL and CCL? Or does the average cost per episode include all episodes?

These are all episodes and so include anything from a cold to a broken leg or a chronic condition. There are several episodes per patient as opposed to the DCL/CCL analyses which only include the chronic illness and have year-long episodes. We are conducting a supplemental analysis that will look at the differential impact on specialists as opposed to PCPs.

What will be the timing of the 2006 rollout of the new POL 2.0 reward structure?

(For example if the Plan would like to time any announcement of their proposed POL rollout accordingly to avoid any discrepancy between the Plan's announced rewards and the rewards listed on the BTE Web site)

POL reward structure will NOT change in NY & MA BTE pilot regions through end of pilot period 7/24/06.

In NON-pilot or POST-pilot BTE markets, regional teams will provide the markets with market-specific reward structures. If you are in either of these markets, please contact your local BTE administrator for rewards amounts.

How are the Physician Office Link rewards determined?

After a practice achieves a passing score on any one or all of the Physician Practice Connections modules, it is eligible to receive a reward for each Bridges to Excellence employee or family member who receives care at the practice. The amounts of the rewards vary depending on the modules passed.

What do physicians stand to gain by participating in Bridges to Excellence?

Top-performing doctors could see income gains of up to 10 percent. In addition, participating physicians are highlighted in provider directories, helping employees and their families identify those doctors who are best suited for treating particular illnesses, or who have exemplary office systems for tracking care.

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