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Bridges to Excellence Program Development

BTE's Recognition programs cover all major chronic conditions, plus preventive care, office systems—and a real Medical Home measurement scheme to promote comprehensive care delivery and strong relationships between patients and their care teams. A list of Care Recognition programs with links to more information is as follows: Asthma, Diabetes, Cardiac, Hypertension, Coronary Artery Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disorder, Spine, Physician Office Systems, and Medical Home.

BTE Recognition programs use standardized sets of measures and criteria to analyze quality of care, including AQA/NQF-endorsed and NCQA-developed measures.

Development of each Recognition program involves the following steps. First, a physician panel is selected to help develop the program. The panel includes a balance of specialists and primary care physicians. Then, an inventory of measures from the National Quality Forum (NQF), AQA, American Medical Association (AMA), Physician Quality Reporting Initiative (PQRI), National Committee for Quality Assurance (NCQA), and the Agency for Healthcare Research and Quality (AHRQ) is performed. The relative strength of each of the measures is weighed to determine the core measures and thresholds for the program. Next, program rules such as patient eligibility and specifications, measures' weights, and Recognition levels and tiers are decided upon. Scoring rules are then defined, which includes defining measures criteria and weights, setting Recognition levels, and developing Recognition tiers. Each BTE Recognition program has three levels of certification, in order to promote continuous quality improvement. They are described as follows:

Level I:

    • Focuses on a clinician-centric view of measurement
    • Individual metrics summed to produce a composite score
    • Inclusion of "minimum" performance requirements for all intermediate outcome control measures, both poor and superior (i.e., BP control and LDL control). 
    • Thresholds have been set to focus on above average performance.

Level II:       

    • Focuses on a combination of clinician and patient-centric measurements. 
    • Level II includes the measurement of individual metrics summed to produce a composite score, with the inclusion of "minimum" performance requirements for all intermediate outcome control measures.
    • Defect rate of care delivery across poor control measures on a per patient basis. 
    • Thresholds have been set to focus on very good performance.

Level III: 

    • Focuses on patient-centric view of measurement
    • Defect rate of care delivery across superior control measures on a per patient basis. 
    • Clinicians must demonstrate that they are using advanced processes and delivering all the right care on a per patient basis. 
    • Thresholds have been set to focus on exceptional

After Recognition levels and tiers are defined, an actuarial analysis is performed in which reward amounts for achieving different levels of Recognition are suggested. When the program is launched, performance data is collected from participants, and assessments and rewards recognitions are carried out. The program is then revised, in which data is analyzed and measures' weights and minimums are recalibrated. Finally, the updated program is launched.

A flowchart of the process can be seen below: