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Frequently Asked Questions (FAQs)

What is the Health Care Incentives Improvement Institute™, Inc.?
Resulting from the merger of Bridges To Excellence, Inc. and PROMETHEUS Payment, Inc., the Health Care Incentives Improvement Institute, Inc. (HCI3) is a not-for-profit multi-stakeholder organization focused on improving health care quality and value with evidence-based incentive programs and a fair and powerful model for payment reform.

Who can participate in HCI3 programs?
HCI3 works collaboratively with clinicians, hospitals, employers, health plans and other health care stakeholders to implement programs in communities across the country.

What is Bridges to Excellence® (BTE)?
BTE is a family of programs to reward Recognized physicians, nurse practitioners and physician assistants who meet certain performance measures.

What is PROMETHEUS Payment®?
PROMETHEUS Payment is a compensation approach, based on medical episodes of care that provides a fair and realistic blueprint for true payment reform.

Why did BTE and PROMETHEUS Payment merge?
The organizations merged for several practical and strategic reasons. Organizationally, the PROMETHEUS Payment pilots operations were staffed by BTE personnel and the merger formalized this operational structure. Strategically, the two organizations' programs are completely synergistic and their aims are almost identical. By combining both entities, the merged organization offer employers, health plans and coalitions a far more robust package of solutions to improve the quality and affordability of care.

How is HCI3 funded?
HCI3's activities are supported by grants from the Robert Wood Johnson Foundation, the New York State Health Foundation, and the Colorado Health Foundation. 


Bridges to Excellence

How do the BTE programs work?
Under the BTE programs, top-performing doctors (as determined by their commitment to meeting standardized treatment protocols) could see income gains of up to ten percent in the form of annual bonuses paid by participating employers and health plans. These physicians will also be highlighted in provider directories, helping employees, members and their families identify doctors with proven outcomes in treating particular illnesses, or whose patient care and support systems are exemplary.

What organizations participate in Bridges to Excellence?
A diverse coalition of physicians, health plans, quality experts, consultants and several of the nation's largest employers participate in the Bridges to Excellence program. Charter employers include General Electric, EMC, IBM, UPS, Procter & Gamble and Verizon – all of which offer bonus payments to physicians who deliver high quality care to their employees

How many health plans participate in BTE?
More than 15 health plans throughout the US. have licensed BTE and are incorporating the BTE principles into their own pay-for-performance programs, allowing purchasers to participate in a boundary-less fashion.

How many employers participate?
As of July 2010, almost 80 employers are participating in BTE nationally.

A listing of current participating organizations can be found here.

How many physicians participate in BTE?
There are currently over 12,000 recognized physicians nationally.

How many patients participate in BTE? How can patients participate?
It is impossible to strictly define the number of patients that are impacted by the improvements in care delivered by recognized physicians because it is based on each panel size of a recognized physician. While the rewards are typically paid based on the number of employees of the participating health plans and employers, the reach of improvement goes well beyond just those patients, but rather to the entire set of patients within that physicians practice. BTE estimates that millions of patients are positively impacted.

Patients can participate in two ways – by selecting a doctor participating in the program or encouraging their own physician to become recognized.

How are the payments determined and when are they made?
Payments to physicians are based on their combined eligible patient counts. All certified/recognized physicians get a reward payment annually.

What is the total payout for BTE across the U.S.?
As of July 2010, physician practices across the country have received tens of millions of dollars in financial incentives for being Recognized. Some practices receive direct bonuses while others receive higher fee schedules from participating plans and employers.

How much can physicians receive in bonus payments?
Each eligible physician's reward amount is traditionally based on the count of eligible employer/health plan patients treated by the physician for that program. There are three levels of recognition in each program tied to different rewards recommendations.  Physicians need to check with their health plan on reward eligibility.

How does a doctor participate in this program?
In order to receive the rewards available under the Bridges to Excellence programs in BTE markets, eligible physicians must pass a corresponding performance assessment program administered by one of the BTE-recognized Performance Assessment Organizations (PAOs). BTE-recognized PAOs include: the National Committee for Quality Assurance (NCQA); MNCM, Minnesota Community Measurement; and IPRO, New York State's Quality Improvement Organization.

How do consumers find physicians participating in BTE programs?
A BTE Recognized physician finder can be found here.

Additionally, consumers can find physicians achieving BTE certification or recognition www.healthgrades.com under Health Grades Physician Quality Ratings link. This information is free of charge to consumers. You may also check the NCQA's web site – htt://recognition.ncqa.org - under the Recognized Physician Registry for a listing of NCQA recognized physicians only. If you find a physician from whom you wish to seek services, check with your health plan administrator to verify the physician's network status.

What's the financial benefit for Bridges to Excellence participating employers? How much can participating employers expect to save?
Employers and health plans collaborating around a specific initiative is the way to catalyze the health care system to change and improve. High quality care can be cost effective care. Studies of patients that are seen by BTE-recognized physicians versus those that go to non-recognized physicians show conclusively that the average severity-adjusted cost of care for those seeing BTE-recognized physicians is lower by about ten percent.

Is Bridges to Excellence seeking participation from other employers and physicians to participate?
Yes. A goal of BTE programs is to continually expand both employer and physician participation with a goal of increasing physician certification. Interested employers and physicians can get more information on the Web site www.HCI3.org or by sending an email to [email protected].



An extensive list of FAQs on the implementation of PROMETHEUS Payment can be found here.

Why was the PROMETHEUS Payment model developed?
The PROMETHEUS Payment model was developed to address the flaws of traditional payment methods, like fee-for-service and capitation.

Who participated in the design of the PROMETHEUS Payment model?
A diverse group of health care experts participated in the design of the program.  A full list can be found here.

How does the PROMETHEUS Payment model work?
In its ultimate expression, based on evidence-informed case rates (ECR®s), the model call for providers to be paid a single, risk-adjusted payment across inpatient and outpatient settings to care for a patient diagnosed with a specific condition. ECRs address treatment issues such as diagnosis, services covered, and criteria for successful completion of care. The end goal is improved health care quality, lower administrative burden, enhanced transparency, and a patient-centered, consumer-driven environment. However, the current expression of the model is to create an ECR budget against which claims that are paid fee-for-service are reconciled. The terms under which the upside is distributed results from the negotiations between plans and providers.

What is an evidence-informed case rate (ECR®)?
ECRs are predetermined budgets that are bundled to cover comprehensive, evidence-based, personalized care in treating a given condition. To date, for pilot purposes, PROMETHEUS Payment has developed ECRs for a number of acute, chronic and inpatient procedures, including heart attacks, hip and knee replacement, diabetes, asthma, congestive heart failure and hypertension.

An ECR is a single, risk-adjusted, prospective budget given to providers across inpatient and outpatient settings to care for a patient diagnosed with a specific condition. ECRs create incentives for providers to deliver care that is safer, more reliable, and consistent with evidence-based guidelines.

What is an accountable care organization (ACO)?
An Accountable Care Organization is any group of providers, organized virtually or physically, that accepts a certain amount of financial risk tied to the actual performance of their services.  ACOs recognize that being paid under the fee-for-service model is not conducive to creating value in health care, and have accepted alternative payment arrangements in which they are financially responsible for the results of the care they deliver.  ACOs can be a group of practices in a community all the way to a large integrated delivery system.

How does the PROMETHEUS Payment model support ACOs?
The PROMETHEUS Payment model is ideally suited to benefit the creation and sustainability of ACOs.  By focusing on medical episodes of care, it allows for much flexibility in the way provider organizations can come together to deliver high value care to patients.  For example, a primary care practice could team up with a cardiology, a nephrology, and a pulmonology practice to deliver coordinated and accountable chronic care management for patients with diabetes, asthma and COPD.  The four practices would not have to legally and financially integrate, more than agree to be jointly accountable for the results in the management of patients.  At the other end of the spectrum, PROMETHEUS Payment can help large integrated delivery systems to better understand the variation in performance within their system and create accountability, incentives and rewards at the medical team level.

How many PROMETHEUS Payment implementations are in progress? Where are they located?
HCI3 is currently working with several implementation partners throughout the country to pilot the PROMETHEUS Payment model.

The following four implementation sites have been funded by the Robert Wood Johnson Foundation: HealthPartners in Minnesota, Independence Blue Cross – Crozer Keystone Health System in Pennsylvania, Employers' Coalition on Health in Illinois and Priority Health – Spectrum Health in Michigan.

In addition, there are implementation sites with the New York State Health Foundation and the Colorado Health Foundation.