Multi-plan Implementations
In states like North Carolina, Georgia and New York, many of the health plans have created incentives for Recognized physicians.
Upstate New York is one of the original BTE pilot markets and has been active since 2004. Since that time, the market and the participating practices have made significant improvements in the care that is delivered. These improvements were motivated and achieved through the BTE collaborative effort and dedicated participation by all stakeholders. What is critical to note is that the improvements impact not just the employees of the participating employers, but all patients that visit the recognized physicians and practices. Some of the best examples of practice transformation come from the Upstate NY region. Recently, Upstate NY has continued to build on the early success, and health plans such as CDPHP and MVP Health Care have supported and incorporated the BTE Recognition programs into their primary care practice network-wide recognition and reward programs.
See the PRWeb article on MVP: MVP Health Care Achieves Bridges to Excellence Physician Incentive and Reward Program Endorsement, June 29, 2010
In 2006, a coalition of employers, insurers and providers came together in partnership with BTE to improve health care quality through implementation of pay for performance. The coalition aimed to launch a three and a half year project to improve the care of diabetes in Georgia by rewarding providers for meeting the NCAQ standards for diabetes care. At the launch of the program, Blue Cross Blue Shield Georgia, United Healthcare, CIGNA, Kaiser Permanente, Aetna, and over 29 employers agreed to participate in the pilot. As a result of the pilot efforts, 250 physicians received Diabetes Care Recognition in Georgia and over $500,000 was rewarded to physicians in incentive payments. Although the pilot officially ended at the end of 2009, many of the plans continue to offer incentives.
In addition, in November 2009 certain WellPoint-owned health plans adopted the BTE measures and integrated them into their internal incentive program, Quality-In-Sights® Primary Care Incentive Program, through the External Recognition program component. As a result of this WellPoint integration, physicians can now receive a specified number of points for participation in BTE. This integration will allow WellPoint to leverage BTE program content as well as additional measures such as technology adoption, generic drug utilization and clinical improvement activities. With the implementation of this new program, BTE will now part of the internal network incentive program
Aetna is currently engaged in implementing the Diabetes Care Recognition program. Participating physicians in GA earning Diabetes Care Recognition will automatically earn BTE financial rewards. These physicians will also be recognized in the Aetna provider online directory DocFind®.
CIGNA supports pay-for-performance programs that feature standardized and agreed-upon measurements among all health plans, employers and providers. CIGNA has existing pay-for-performance contracts with individual providers in Georgia which pay incentives for diabetes.
Within United Healthcare, primary care physicians and endocrinologists Recognized for Diabetes Care will meet the UnitedHealth Premium quality criteria.
The North Carolina Collaborative included a host of local employers and health plans that operate in the state and have licensed BTE. This includes Blue Cross Blue Shield North Carolina (BCBSNC), Aetna, CIGNA, and United Healthcare. The North Carolina State Health Plan was one of the initial purchasers to participate in BTE. They aim to ensure consistent care delivery and to reinforce the goal of improving health care quality and value through aligning information systems with effective care. Raleigh and Charlotte were the original areas of focus. The program includes Diabetes Care, Cardiac Care and Physician Office Systems Recognition. The pilot officially ended at the close of 2009.
Aetna is currently engaged in implementing the Diabetes Care, Cardiac Care, and Physician Office Systems Recognition programs. Participating physicians in Raleigh and Charlotte earning one or more of the BTE recognition programs will automatically earn BTE financial rewards. These physicians will also be recognized in the Aetna provider online directory DocFind®.
CIGNA supports pay-for-performance programs that feature standardized and agreed upon measurements among all health plans, employers and providers. CIGNA has existing pay-for-performance contracts with individual providers in Raleigh and Charlotte which pay incentives for diabetes, cardiac care and internal physician office practices.
Within United Healthcare, primary care physicians and endocrinologists recognized for diabetes care will meet the UnitedHealth Premium quality criteria. Primary care physicians recognized for cardiac care will also meet the UnitedHealth Premium quality criteria. This provides physicians with an alternate way to achieve the UnitedHealth Premium designation.
BCBSNC has introduced its Blue Quality Physician Program as a result of its successful implementation of BTE. The three-year pilot program, which concluded in April 2009, brought BTE to North Carolina by offering incentive payments to physicians meeting national standards. BCBSNC determined that providing these incentives resulted in a payoff which included physicians achieving higher quality measures and having lower costs per patient. For example, when compared to patients of non-Recognized physicians, patients of Recognized physicians meeting BTE quality standards received fewer high-cost imaging tests such as CT scans and visited the emergency department less often.
The program is open to North Carolina primary care physicians, including family and general practitioners, internists, pediatricians, obstetricians and gynecologists, who agree to BCBSNC’s standard contract for in-network physicians. Participating physicians in Blue Quality Physician Program earn higher reimbursement by achieving standards in three categories. The categories are clinical quality outcomes, which include recognitions by the NCQA, use of electronic prescribing, and other standards; administrative efficiency, including electronic claims submission; and patient experience with care, which measures physicians’ ability to provide patient-centered care such as after-hours care and electronic visits.