CareFirst BlueCross BlueShield BTE: Health Plan Implementation
Plan Description
CareFirst BlueCross BlueShield (CareFirst) launched a Bridges to Excellence pilot program in the following regional areas: Maryland, District of Columbia, Northern Virginia, and Delaware. The products offered by CareFirst are: Point of Services (POS) plans, Preferred Provider Organizations (PPO’s), Managed Care Organizations (HMO), and Consumer Direct Health Plans. Currently membership at CareFirst, including Federal (FEP) program members, is at over 3 million with a market share at 39% in this service area. CareFirst is a licensee of the Bridges to Excellence Program and rewards physicians in the Physician Office Link (POL) program. In the first year, a total of $1,360,000 was awarded to physicians.
Engaging Stakeholders
Before starting the Bridges to Excellence program, CareFirst was already rewarding physicians through its existing Pay For Performance program. However, BTE is a key component of the commitment focusing on initiatives designed to improve quality of care and patient safety. The pilot is consistent with the business strategy and looks to enhance partnerships with physicians and organizations to promote quality and patient safety.
CareFirst engaged multiple stakeholders in the marketplace to support/endorse the BTE concept prior to the launch throughout the recruitment period. These included the Regional Business Coalition, BlueCross BlueShield Association, Delmarva Foundation (QIO), Medical Societies, Heart Association, and Medical Groups.
CareFirst’s BTE Process
CareFirst launched the $4.5 million pilot for the BTE project in 2005. It’s the first health plan (rather than employer) providing financial incentives through the POL program. The pilot program recognizing and rewarding physicians is a 3-year pilot (2005-2007) with approximately 20 sites in the service area. Over 50,000 CareFirst members are affected.
Selected pilot practices are required to pass the NCQA Physician Practice Connections (PPC) Certification. In order to achieve maximum rewards in the first year, the practice must pass at least one module in each of the three standards categories: Clinical Information Systems/Evidence–Based Medicine, Patient Education and Support, Care Management. And in each of the next two years, in order to achieve full rewards, they must pass an additional module in each of the three categories. If additional modules are not achieved, the reward amount is reduced.
CareFirst collaborates with medical practices and assists with the survey process, if requested. CareFirst also reimburses the survey fee upon successful completion of at least one module of the PPC survey. Once certified, the practice receives recognition in the provider directory and financial rewards.
Recruitment/Selection
All network PCPs were invited to apply for the pilot. Multiple forms of invitations were distributed via email, postcard, and personalized letters to practices that were recommended from internal and external sources with an invitation to apply. Phone lines and email accounts dedicated to questions regarding the program were also made available. The application was posted on the CareFirst website. A total of 68 practices completed applications in the service area, which was a total of 214 physicians. Thirty primary care practices (100 physicians) were selected to participate in the pilot program. In 2005, 82 physicians from 20 practices were PPC certified.
Unique Challenges
First Year Results
In 2005, thirty PCP practices were selected for participation in the three-year pilot program.Twenty two of those practices applied to NCQA and 20 were successful. There are 82 physicians at these locations taking care of over 50,000 CareFirst members. CareFirst provided $1,360,000 in rewards in 2005.
Within the pilot, there have been multiple innovations that occurred as a result of the program. These activities include the following: