Participation > Health Plans

Licensing Bridges to Excellence Programs

Becoming a Health Plan Licensee of the Bridges To Excellence (BTE) programs is easy.  You must simply execute a BTE licensing agreement and pay a modest licensing fee.  All BTE licensing agreements are made for a 3-year period.  In licensing BTE programs, health plans have the non-exclusive right to implement BTE programs for their plan members for the period of the agreement. 

What does it cost to become a BTE Health Plan Licensee?

There are two primary costs associated with becoming a BTE Health Plan Licensee:

    1. BTE Health Plan Licensing Fee
    2. BTE Recognition Data Exchange Fees

1.  BTE Health Plan Licensing Fee:

As previously mentioned, health plan licensees are given the non-exclusive right to implement BTE’s programs for their plan members on behalf of their self-insured customers or for their own fully-insured book of business. Moreover, they are authorized 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 based upon the licensing fee schedule listed below. Please note that the amounts quoted are the annual licensing fee costs .

Annual Licensing Fee Schedule:

Multi-State Plan:  $150,000

Any healthcare benefits company with holdings and/or operations in more than one state.  This applies to national health plans as well as state health plans with assets and the license to operate in more than one state and/or territory.

 Single State Plan:  $50,000

 Any healthcare benefits company with holdings and/or operations limited to a single state, including more than one region within a state.

Regional Plan: $25,000

Any healthcare benefits company with holdings and/or operations limited to a single region within a state or could potentially cover a small region within a state.  A “region within a state” is defined as a self-limiting geographic area in which routine plan operations take place.

2.  BTE Recognition Date Exchange Fees:

The BTE Recognition Data Exchange (RDE) is the universal platform that all health plans, performance assessors and partners use to administer BTE and reward physicians.  It is designed to consolidate reward eligibility data across and within market regions and disseminate physician performance information for the purpose of paying rewards.

A modest fee for RDE maintenance and administration is charged to licensees for ongoing participation in the BTE RDE.  BTE RDE fees are based on a per member per month (pmpm) calculation.  The pmpm information is assessed for all covered lives[1] collectively from all participating health plans and employers within a region[2].

The RDE fees are intended to cover BTE’s costs only. RDE pmpm costs can range from $.02 to $1.00 depending on the program/size of the region, with the total number of participating covered lives in a region acting as the primary driver behind this cost. The BTE RDE fees for a region may equal but shall not exceed a total of $150,000 per market region per year across all plans and employers participating in a region.  BTE continues to find ways to decrease these costs and will always pass any savings on to the plans and employers.  View more information on how the RDE pmpm fee is calculated and invoiced.

Are there any other costs associated with becoming a BTE Health Plan Licensee?

The BTE licensing and RDE pmpm fees are the standard cost considerations for a health plan licensee considering a regional implementation.  Other optional BTE administrator-related costs have been pursued by other licensees, but are not required by BTE of its licensees.

For more information on these optional BTE administrator-related costs and/or becoming a licensee of the BTE program please contact our National Accounts Manager.

[1] Definition of Members (Covered Lives)

  • Enrolled covered employees and dependents living within the specified geographic area
  • Attributed to a BTE eligible physician (as defined in the MPL toolkit)

[2]  A BTE market region is defined by a set of geographic parameters delineating the capture area for physician eligibility and participation in BTE administered programs.  These parameters are established and agreed upon by participating BTE Plan administrators seeking to operate in the said “market” and reviewed on an annual basis.

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Bridges to Excellence does not endorse any particular product or service or any physician or physician group.

Bridges to Excellence relies on third -party performance assessment organizations such as the NCQA and Quality Improvement Organizations to measure a physician or physician's group performance and ability to demonstrate that they meet certain measures of quality care.