Becoming a Bridges to Excellence (BTE) program licensee brings along with it a number of responsibilities and obligations, the most important of which is adherence to the BTE guiding principles of program implementation.
BTE Guiding Principles of Program Implementation:
BTE is committed to supporting its health plan licensees in the process of becoming BTE program administrators. As such this page was created to provide health plans licensees with the knowledge and tools to best perform their licensee duties. It contains sections on administrator roles and responsibilities, strategies on gaining program administration efficiencies through “baking in” BTE, and finally an approach to new and current BTE markets. This page should be viewed and used by health plans as one of many resources available to them for information on BTE program administration, and contains the following information:
BTE Administrator Roles & Responsibilities
** Administrators are encouraged to use data structures that they have available**
Implement BTE for specific BTE participating organizations
By licensing the program, health plan licensees are given the non-exclusive right to implement the BTE programs for participating organizations, namely employers. However, the rights granted by the license regarding implementation are not limited to self-insured employer plan members, but allow plans to also implement the programs for their own fully-insured book of business.
Data Attribution & Exchange
Program administration is comprised primarily of two components, the data portion and the financial/rewards portion. The data component requires that the program administrator create a physician-patient data attribution file called the Master Physician List (MPL) and facilitate interface/exchange of the MPL with the Recognition Data Exchange (RDE). Get more information about the BTE RDE.
The BTE MPL is the means by which administrators identify BTE eligible physicians and their associated BTE-eligible patient counts. The total patient count forms the basis behind program rewards for a physician once they obtain recognition in 1 or up to all 3 BTE programs. BTE-eligible patients include patients who are associated with a BTE participating organization and are attributable to a BTE-eligible physician.
BTE has developed a suggested physician-patient attribution methodology based on claims data using ICD-9 codes to provide administrators with some guidance in the development of the MPL. However, please note that administrators are not limited in the specific choice of methodology used to carry-out the physician-patient attribution process, and are encouraged to leverage pre-existing plan resources such as ETG software to create the MPL. For more info on alternative BTE-approved physician-patient attribution methodologies please contact our National Accounts Manager.
The aggregated physician and patient count information captured in the MPL is then reformatted to interface with the BTE Recognition Data Exchange (RDE). The RDE is the universal platform that all health plan administrators, 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. The RDE uses a standard format and a predetermined data-exchange schedule.
Training on both the MPL development and RDE data exchange processes are provided to all health plan licensees by Bridges to Excellence Operations. Contact BTE for more details on MPL/RDE training.
Communicate to Physicians
Health Plans maintain strong relationships with the physicians in the community, and together with BTE participating employers, are responsible for communicating program administrative details, such as eligible patient counts and reward amounts to their providers. These communications may also include solo or joint recruitment efforts of providers into the BTE programs. BTE provides administrators with the information to drive these conversations. However, similar to the discussion around MPL development and physician-patient attribution, BTE does not limit the means by which administrators may carry out this function, but instead encourages them to leverage pre-existing processes and follow a “do what works best for you” strategy.
Invoice Employers
BTE administration for plan members on behalf of a self-insured customer is most often (but not necessarily) carried out by the health plan licensees under the agreement that the customer fund the program rewards. Details around the program rewards, invoicing of employers and other BTE administrative duties may be captured in a separate employer-health plan agreement and or embedded into pre-existing contracts between the parties. Once again BTE does not limit the means by which administrators may choose to carry out this function, encouraging a “do what works best for you” strategy.
Distribute Rewards
Whether funding for the program rewards comes from self-insured customers or the health plan itself (for its fully insured member participants), distribution of the rewards is a BTE administrator responsibility. Agreement on the details of rewards distribution such as frequency and timing of rewards are market level decisions to be reached between participating administrators in a region in order to assure consistency. BTE encourages discussion of these issues with participating providers to assure that the market needs are aligned with those of the physician practices in the community.
Post Recognized Physicians/Practices to the Web Site
The Bridges To Excellence pilot program evaluation revealed that benefits of program participation arise not only from the delivery of higher quality care at lower costs to patients seen by BTE participating physicians, but also from the increase of patient volume seen by these high performing providers. In order to promote this volume shift and power the consumer healthcare decision-making process, plans should look to post recognized physicians/practices on their websites.
For more information please review BTE's Reward Administration Guidelines.
BTE Health Plan Licensee Strategy: “Baking In” BTE
What is BTE “Baked In”?
“Baking In” BTE is the process by which health plan administrators integrate Bridges to Excellence administration and program content into the fabric of a plan’s structures, processes and products. This involves working with the Bridges to Excellence National Accounts Manager to work on plan-specific BTE integration solutions that will allow licensees to gain maximum value from BTE program participation.
What does “baking in” BTE mean to a health plan licensee?
A “baked in” BTE solution supplies an administrator with the opportunity to leverage BTE program content to power the plan’s other programs and products. It means looking to the BTE program(s) as a package of clinically-powered performance measures data that can be used to strengthen plan specific physician performance programs and products.
An integrated solution also provides administrators with the opportunity to execute BTE in a most efficient fashion, by leveraging pre-existing health plan data and payment processes to carry out program administration. It means identifying plan specific methods that could be applied towards the efficient administration of the BTE programs.
If you are interested in pursuing or have any questions on how your plan could go about arriving at a “baked in” BTE integrated solution please contact our National Accounts Manager.
Understanding Current Markets
To date, BTE has program implementations up and running in 12 markets covering 13 states, with new interested markets springing up daily. Given the rapid growth of BTE program adoption and the fact that most health plan licensees act as participating administrators in more than one regions/market at a time, it is important that plans receive regular comprehensive updates on the status of BTE markets.
In order to facilitate this process, BTE has created a 2007 market matrix which lists BTE markets and ranks them according to the relative degree of engagement and program implementation.
Above you will find the 2007 markets matrix along with a complete summary of BTE markets status definitions. It is our hope here at BTE that this information will provide health plan licensees with a firm understanding of the BTE markets, and give them insight into the status of new upcoming markets.
Identifying New Markets:
The goal of Bridges to Excellence is to influence physicians and medical practices to change their behavior regarding the care of patients. In order to achieve this change the healthcare environment in a market must be right. Below is a listing of some criteria to consider when evaluating new markets to approach.
To achieve this change, the incentives or rewards available to physicians must be of sufficient size. The amount of physician rewards is tied to the number of participating purchasers' covered lives who are seen by physicians -- the higher the number of purchasers' covered lives in a geographic area, the higher the potential reward available to the physicians who treat these purchasers' members. As a result, the combined number of covered lives of purchasers' in a market area must represent a sufficient segment of the local population to ensure the BTE reward program is effective.
In general, BTE participating purchasers' combined count of covered lives in a specific geographic market area should be:
If you are a purchaser who is interested in launching BTE in a new market area, determine your organization's number of covered lives (covered employees, dependents, and retirees) in the specific geographic area. If your organization alone has a sufficient number of covered lives to impact physicians in the market, you may be able to participate in BTE as an individual purchaser. More commonly, if your organization alone does not have enough covered lives to ensure significant physician impact in a market area, then you can participate in BTE by identifying other local purchasers who are interested in BTE, such that a significant number of covered lives is represented when combined across all interested purchasers.
When you have identified a sufficiently large number of covered lives in a new geographic market area, either as a single purchaser or combined with other interested purchasers, please contact Bridges to Excellence's National Coordinator.
Guide to Meeting the Common RFI
In response to Executive Order 13410 regarding value-based purchasing of health care, the Office of the Secretary of Health and Human Services has issued a sample request for information (RFI) for health plans. The questions in the RFI focus on health plans’ activities in support of the "four cornerstones" of the Executive Order.
Bridges to Excellence and the Leapfrog Group offer several pay-for-performance programs that are consistent with the goals of the Executive Order. Health plans implementing these P4P programs already meet many of the requirements of the RFI.
The four cornerstones of the Executive Order are:
As such, BTE and Leapfrog have created a Guide to Meeting the Common RFI. The purpose of this guide is to assist health plans to complete the RFI by indicating which RFI elements are met through implementation of BTE or Leapfrog programs.
If you need more information or are interested in licensing BTE please contact our National Accounts Manager.