STEP 3: Define and Agree on Scope of Pilot
Next, the scope of the pilot is defined and agreed upon. Agreements are made regarding which Evidence-Informed Case Rates (ECRs) and measures will be implemented, and which providers, provider specialties, and health systems to engage.
Case Study: Employers Coalition on Health
In the Rockford, IL pilot, very clear commitments were made during the early implementation phases of the pilot. The Employers Coalition on Health (ECOH) and the health systems participating in the pilot identified Diabetes, Coronary Artery Disease, and Hypertension as areas for quality improvement and reduction of the dollars spent on Potentially Avoidable Complications (PACs). If, at the end of the first year of the pilot, PACs were reduced in these three domains, the employers would benefit from cost savings and the providers would benefit from potential bonus opportunities. The bonus opportunities available to the providers would not only be contingent on the reduction of PACs, but also on the adherence to a minimum quality threshold. As such, the pilot participants employed the performance measurement programs offered through Bridges to Excellence. Each health system was required to submit clinical data on a series of national quality metrics related to Diabetes, CAD, and Hypertension. These metrics included process and intermediate outcome measures.
The selection of ECRs is entirely up to the pilot site partners, but the initial ECR analysis can help to inform the decision. For example, we have observed that most pilot sites take four key decision criteria into account: 1) Does the ECR represent a potential cost savings opportunity? 2) Is this condition/procedure an area in which quality improvement efforts should be focused? 3) Are there existing quality improvement efforts taking place around this particular condition or procedure currently? And, how can those efforts be leveraged? 4) Is this ECR/focus area consistent with our mission? (e.g. interest in becoming a destination center for a certain procedure; interest in becoming known for providing excellent chronic care management)
The outputs of these data runs are shared and reviewed with the site in detail so they can make an informed decision as to which ECRs they would like to implement.
Implementation sites choose at least one of the following 21 ECRs:
Chronic Medical: Asthma, CAD, CHF, COPD, Diabetes, GERD, HTN
Inpatient Procedural: CABG, Colon Resection, Bariatric Surgery, Hip Replacement, Knee Replacement
Outpatient Procedural: Colonoscopy, Cholecystectomy, Hysterectomy, Knee Arthroscopy, PCI (Arthroscopy), Pregnancy/Delivery
Acute Medical: AMI, Pneumonia, Stroke
Partners are also expected to select one or more of the BTE Care Recognition Programs to implement in addition to the ECRs. The BTE Care Recognition Programs are intended to identify clinicians who deliver high-value care to patients. BTE’s Care requirements assess clinical measures representing standards of care for patients with the condition or illness being assessed. Below are the links to each BTE Care Recognition Program.
Asthma Care, Cardiac Care, Cardiology Practice Recognition, Congestive Heart Failure Care,
COPD Care, Coronary Artery Disease Care, Depression Care, Diabetes Care, Hypertension
Care, Physicians Office Systems, Spine Care, BTE Medical Home
The specifications of each BTE Care Recognition Program are carefully reviewed with the pilot site before the programs are selected. Click here to review the specifications for each Recognition Program (these are the Policies and Procedures manuals that were mentioned earlier in Step 2). Clinicians will be expected to submit clinical data to an independent third party for scoring on the chosen recognition programs.
Useful examples for scoping out the pilot:
Sample scope document This is a document from the pilot site in Rockford IL, which outlines the scope of their pilot.