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Employer-Led Implementations

In states like Minnesota, New Jersey, Maine, Pennsylvania, Colorado, and in communities like Cincinnati, Ohio, employers and health plans are working collaboratively to implement one or more BTE Recognition programs.

Cincinnati, Ohio

Cincinnati, OH, is one of the original BTE pilot markets and has been active since 2003. Since that time, the market and the participating practices have made significant improvements in the delivery of care to diabetic patients. These improvements were motivated by and achieved through the BTE collaborative effort and stakeholder participation. What is critical to note is that the improvements impact not just the employees of participating employers, but all patients that visit the Recognized physicians and practices. Some of the best examples of improvements in diabetes care come from the Cincinnati region. For example, the Health Improvement Collaborative of Greater Cincinnati has a long-standing history of working to improve the quality of care delivered to patients in the region by providing resources to providers and consumers alike. More recently, they have undertaken a public reporting initiative as part of the Aligning Forces for Quality effort in the community. To decrease the burden of reporting, physicians and their practices are able to submit data for performance measurement directly to the HealthMeasures portal or via HealthBridge, a local Health Information Exchange. As part of the reporting process, the data are automatically assessed for BTE Recognition in an effort to achieve “one and done” reporting. After such success with the diabetes program, the community will be incorporating a cardiac care pilot in the near future. Cincinnati exemplifies the successful collaboration between employers, providers, coalitions, and quality improvement organizations that is necessary to improve care at the community level.


The Colorado Business Group on Health (CBGH) is currently engaged in implementing the BTE Diabetes Care Recognition and Cardiac Care Recognition programs in Colorado Springs.  The coalition had previously implemented a diabetes education initiative in Colorado Springs that focused on improving the detection, education and benefit-design structure for consumers with diabetes. Among its consumer tools, CBGH also publishes an annual health plan report card called Health Matters. CBGH is an employer-focused coalition serving the entire state of Colorado that continues to promote improvements in healthcare quality through pay-for-performance programs like BTE.

New Jersey

BTE was launched in New Jersey in 2008 with the Diabetes Care Recognition program. Through this program clinicians are rewarded for the quality of care they provide, not the number of tests or procedures they perform. Increasing the number of physicians that are recognized in the Diabetes Recognition program will not only improve the quality of care delivered to patients with diabetes, but it is estimated to also save New Jersey more than $60 million per year in avoidable health care costs and may result in annual rewards for physicians of $8 - $12 million. The coalition of employers, health plans and providers have worked tirelessly to rally support across New Jersey. Aetna, a BTE national licensee, rewards physicians who participate in BTE on their commercial book of business. Several large and small employers, such as Verizon, NovoNordisk, PSE&G participate through encouraging their employees to seek care from a Recognized physician as well as providing financial support. 


After experiencing success with its local Pathways to Excellence (PTE) primary care practice initiative, the Maine Health Management Coalition (MHMC) began transitioning to BTE's national platform beginning in 2008. As of 2010, practices are recognized for use of clinical systems and excellence in diabetes or cardiac care. The transition to BTE aligns MHMC PTE with what is happening in the national environment, provides opportunities for physicians to achieve a variety of levels of recognition, increases opportunities for practices to achieve recognition (year round vs. annual), reduces the potential for duplicative reporting, and speeds up cycle time between the time a practice reports and receives their results on which to take improvement action.
Established in 1994, the MHMC is a statewide, mixed-model, employer-led coalition with a membership that includes public and private employer purchasers of health care, hospitals, physicians and insurance/health plans. The MHMC's mission is to work collaboratively to maximize improvement in the value of healthcare services delivered to MHMC members' employees and dependents.

Minneapolis, Minnesota

The Buyers Health Care Action Group (BHCAG) is a large employer business coalition committed to reforming the delivery of health care in Minnesota.  Over the last 19 years, BHCAG has been a catalyst for many market reform initiatives.  BTE is one of BHCAG's initiatives aimed to create a tipping point for physicians to re-engineer care processes and to provide incentives to improve health care outcomes rather than simply delivering additional services.

The Minnesota market has several existing building blocks that have accelerated the implementation of BTE. For instance, pay-for-performance programs have been in place for several years in Minnesota through all major health plans.  Also, the Institute for Clinical Systems Improvement (ICSI), a physician-based organization, has developed clinical guidelines, provided support for implementation of these guidelines, and developed measures for performance evaluation through a broad range of community physicians. In addition, MN Community Measurement (MNCM) was formed in 2002 by several local health plans as a collaborative to collect performance data.  By aggregating health plan claims data and collecting clinical information from physician offices, MNCM publicly reports physicians' performance results.

As BHCAG began to implement BTE in 2005, it formed a Guiding Coalition comprised of multiple community stakeholders including representatives from 4 of the market's largest health plans: Stratis, the Minnesota QIO; the Minnesota Medical Association (MMA); several large employers, providers, ICSI, and MN Community Measurement.  BHCAG and the Guiding Coalition continue to guide the design, development, implementation, and ongoing strategy for BTE in Minnesota.

An extremely valuable by-product of the Guiding Coalition's work was achieving consensus among the health plans to use the same composite measure for all Minnesota pay-for-performance programs for diabetes and coronary artery disease (CAD). Going forward, the Guiding Coalition will strive to achieve greater alignment across payers in all Minnesota pay-for-performance programs in order to provide a clear and strong signal to physicians that high quality care and good patient outcomes will be rewarded.

See a StarTribune.com article: Group Rewards Clinics with Cash for Quality, June 24, 2010


The Pennsylvania Employee Benefit Trust Fund (PEBTF) and HCI3 have partnered together to engage top volume Pennsylvania practices in a pilot chronic care management assessment program. PEBTF is one of the largest payers of health care services in PA, covering over 300,000 PA State employees, retirees and family members. Approximately 85,000 members have a chronic illness. PEBTF’s commitment to improving the quality and affordability of healthcare for its members was the impetus for partnering with HCI3. The purpose of implementing BTE is to not only reward physicians who obtain Recognition, but to determine which physicians are delivering a higher quality of care to patients with chronic illness. Physicians who obtain Recognition will be rewarded monetarily by PEBTF. The pilot program is assessing selected clinicians and practices in the following Care Recognition programs: Asthma, Coronary Artery Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disorder, Diabetes, and Hypertension. Practices are being asked to apply for Recognition in all the programs they are eligible for.