Bridges To Excellence

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Bridges To Excellence

• Health Plan Quarterly National Update
• November 4th 2008

Jessica DiLorenzo, Operations Director Mike
Capizzi, Accounts Manager
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Agenda

• Progress on 2008 strategy 2009 overview
• Performance Assessment System multiple pathways
  for recognition
• Expansion of BTE Care Links
• Regional updates and new regions
• Integrated timeline
• 2009 call schedule
• Feedback on agenda topics for 2009
• Meeting Adjourned

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BTE 2008 Strategy and Goals, and Beyond

• Promote and advance delivery of high quality care
  thru practice transformation and care
  reengineering
• Reliable Credible data
• BTE Automated Performance Assessment System
  allows for rapid and dependent medical
  record-based physician performance evaluations
  by connecting local and national medical record
  data sources to a network of performance
  assessment organizations
• Critical Mass
• BTE Programs Strategy allows for a reduction in
  the signal to noise ratio across regional
  efforts by calling for an increase in the number
  and breadth of BTEs plug and play
  programs and tiering of existing ones
• BTE Health Plan Distinction Programs promotes
  the adoption and application of BTE core
  principles (i.e. community collaboration,
  recognizing and rewarding good quality) in
  health plan P4P programs.

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• Reliable and Credible Data

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Over 12,000 BTE physician recognitions today

• of recognitions
• 1000
• 500-999
• 200-499
• 50-199
• 1-49

and with more pathways to recognition
available, the numbers will continue to grow
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Each PAO takes in data from different sourcesall
electronic
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Were continuing to grow this list

• ABIM (national)
• GE
• NextGen
• BioSignia
• DocSite
• MHMC (ME)
• Cleveland AF4Q
• Greenway
• MAeHC
• Partners (MA)
• NYCDOH
• THINC (NY)
• HealthBridge (OH)
• IHIE (IN)
• not shown

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• BTE Care Link Programs

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Levels of recognition promote continuous quality
improvement

• Three levels of recognition
• Level I Classic measurement of individual
  metrics summed to produce a score. Minimum
  requirements on poor control discrete measures.
• Level II Scoring based on a combination of
  discrete and composite measurement. Minimum
  requirements superior control discrete measures
  and inclusion of poor control composite
  measurement.
• Level III Physicians must demonstrate that they
  are using advanced processes and delivering all
  the right care to patients. Inclusion of
  composite measures for poor superior control.
• Having three levels is consistent with most
  recommendations by experts today of rewarding
  potential for improvement (Casalino1, Rosenthal2)

1. Casalino, L.P., et al. (2007). Will
Pay-For-Performance And Quality Affect Health
Care Disparities? Health Affairs 26
(3)405-414. 2. Rosenthal, M.B., and Dudley.
R.A..(2007). Pay for Performance Will the Latest
Payment Trend Improve Care? JAMA 297740-744.
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Future BTE Programs will be developed in
collaboration with our partners

• ABIM
• Hypertension Care Link (HCL) Q4 2008
• Preventive Cardiology Care Link (PCCL) Q2 2009
• Comprehensive Care Management Link (CCML) 3Q
  2009

• Non-ABIM
• COPD Care Link Q4 2008
• CHF Care Link 1Q 2009
• CAD Care Link 1Q 2009
• Asthma Care Link 1Q 2009
• Depression Care Mgmt Link 4Q 2009
• Pediatric Care Link (in collaboration with NCQA)
  4Q 2009

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• Regional Update

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Regional Plan Expansions

• Texas Houston
• Houston Healthcare Collaborative, plans CIGNA,
  Aetna (Austin pilot) , BCBSTX, UHC
• Employers DOW, H.E.B, and public employers
• Physician support Diabetes America, Medical
  Society
• Status program and reward design to be
  confirmed, license BCBSTX
• Florida Central and South Florida
• NBCH Coalition Florida Healthcare Coalition
  engaging
• Cardiac Care Link
• Status program and reward design to be
  confirmed, license BCBSFL
• Georgia
• CHT leading stakeholder engagement locally
• Adding Cardiac Care Link, and program levels
• Expanding pathways to recognition w/ NextGen and
  Wellstar

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Regional Plan Expansions

• Montana Statewide effort
• NBCH Coalition Montana Association of Health
  Care Purchasers
• NextGen presence
• Status presentation on Nov. 8th to finalize
  interest and implementation, license BCBSMT
• Ohio Cincinnati, Akron/Canton, Cleveland
• Cincinnati AF4Q site current BTE region, HIE
  in the mix
• Akron/Canton Local coalition interest
• Cleveland AF4Q site
• Maine transition from PTE to BTE
• Health plans using the PTE ribbons currently
• Expanding pathways to recognition direct
  submission, EMR
• Limited employer engagement

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Regional Plan Expansions

• Oregon
• Clear Choice Health Plan
• Presence also in MT Serves 40,000 residents
• BTE Licensing and RDE Agreement in progress
• Allscripts and eClinical Works are major EMR
  vendors with ties to their larger practices
• California
• LA Care
• Managed Medicaid Plan Serves nearly 800,000
  members
• In progress of developing MPL conducting
  feasibility analysis

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Current Participating Health Plans

• Aetna - GA, DC, NC, WA, ME, NJ
• Anthem-Wellpoint GA, OH, CO
• Blue Cross Blue Shield of Alabama
• Blue Cross Blue Shield of Georgia
• Blue Cross Blue Shield of Massachusetts
• Blue Cross Blue Shield of North Carolina
• CareFirst Blue Cross Blue Shield

• CDPHP (Upstate NY)
• CIGNA - GA, NC, MA
• Horizon Blue Cross Blue Shield - NJ
• Kaiser Permanente of Georgia
• MVP Health Care (Upstate NY)
• Tufts Health Plan
• United Healthcare GA, NC, OH, KY, CO

BTE Recognized/Endorsed Health Plan
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• Timeline

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Integrated Timeline
June
Apr
Dec
Jan
Feb
Mar
May
NextGen
GE
Allcsripts
DocSite
PAO System
ABIM
Biosignia
eCW
CHF
HCL
PCCL
Care Links
CAD
COPD
Asthma
OH
GA
TX
MN
ME
Regions
MT
FL
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2009 Call Schedule

• Q1 February 3rd, 1PM EST
• Q2 May 5th, 1PM EST
• Q3 August 4th, 1PM EST
• Q4 November 3rd, 1PM EST
• Dial In 888-804-7998 Guest Code 303374

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How to improve in 2009

• Other Agenda topics?

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