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| Greetings!
Welcome to the third edition of Bridges to Excellence Building Bridges newsletter. Read on to learn more about our continued efforts to improve the health care system and physician performance assessment.
In this issue:
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CEO Corner
Health Care Reform
It's been a hot summer, and not simply outside. The temperature inside Town Halls across the country clearly boiled over and so did the tempers. And in the midst of all the summer follies, we seem to have forgotten the essential need for heath care reform. In a recent NEJM Perspective that I penned with co-authors Meredith Rosenthal from the Harvard School of Public Health and Michael Painter from the Robert Wood Johnson Foundation, we show the projected increase in health care costs for the private sector in the next decade, and the news is more than concerning. The status quo will result in $1 trillion being added on the shoulders of employers and employees, a veritable tide of red ink. That's an extra $4,000 for every employee and for every dependent. Without a significant increase in productivity and/or revenue growth, most companies will experience flat or negative earnings because their profit per employee will be completely consumed by the increased medical costs. It is, very literally, a recipe for national disaster and it's time to face it head on and take some serious action to bend the cost curve.
We've recently developed a series of programs and tools to help employers take action now to stem this tide of red ink. First, you should know your numbers:
- How much money are you spending in potentially avoidable costs? As the NEJM Perspective specifies, these consume, on average about $2 out of every $10 you're currently spending. Knowing that number and holding yourself, your employees, the delivery system and plans accountable for jointly reducing it will force massive change in the status quo. We can help you figure out your number.
- How many of your employees with chronic conditions are seeking care from BTE-recognized physicians? On average, these physicians save you at least 6% on the total yearly costs of care. That might not seem like a lot, but it sure helps in stemming the red ink. Increasing the number of BTE-recognized physicians is simple and our studies demonstrate that clearly. You need to get your plans to pay for results and recognition, not simply volume. You can also increase the number of patients going to recognized physicians by tiering your co-pays. We can help you design a strategy that will work for you.
Once you know your numbers, the rest is about operations and contracting. The good news is that all the health plans we work with are engaged in robust value-based purchasing, especially the ones we've endorsed. Know your numbers and take action. And don't get distracted by the "follies" because they won't stem the tide of your red ink. Only you can, and we can help you.
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 Programs Update
BTE/NYC DOHMH TCNY Recognition Program:
There are a number of collaborative public and private sector efforts to change the incentives to and structure of the delivery system, but none reach the scale of New York City's efforts. Bridges to Excellence (BTE) is partnering with the NYC Department of Health and Mental Hygiene (NYC DOHMH) to develop the Take Care New York (TCNY) quality recognition program for primary care physicians across the City's five boroughs. In an attempt to improve population health management through technology and health information exchange, the NYC DOHMH established the Primary Care Information Project (PCIP). PCIP supports the adoption and use of Electronic Health Records (EHRs) amongst community-based primary care physicians that serve the needs of the 5 million residents in the metropolis. To date, over 1600 physicians have taken advantage of the program, with the number expected to reach 2000 by year's end.
As part of PCIP, participating physicians leverage their EHR system to report on a basket of quality measures, which are then electronically delivered to a citywide Quality Reporting Warehouse (QRS). Bridges To Excellence's role is to establish the assessment process, measurement and recognition for physicians that demonstrate they are delivering good quality care. In addition, this Take Care NY Primary Care Recognition Program will be used by health plans in the City to trigger incentives and rewards. The first batch of physicians to be formally assessed through this program is expected to come through in early 2010.
For more information on the BTE/NYC Department of Health and Mental Hygiene 'Take Care New York" Recognition program contact Edison Machado, Jr, MD, MBA.
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PROMETHEUS Update:
From the Prometheus ECR development desk, it has been a very productive summer. We have updated and completed the SAS packages to automatically run three out of the four ECR types:
1) Chronic care ECRs including CHF (congestive heart failure), CAD (coronary artery disease), Hypertension, Diabetes, COPD (chronic obstructive pulmonary disease) and Asthma;
2) Inpatient Procedural ECRs including Hip Replacement, Knee Replacement, Bariatric Surgery, CABG (coronary artery bypass graft) surgery and Colon Resection
3) Inpatient Medical ECRs including AMI (acute myocardial infarction), pneumonia and stroke
We are working on the last SAS package and have already completed ECRs for angioplasty and colonoscopy. We are now constructing our 17th ECR for Pregnancy and Delivery. Dr. Elliott Main and Dr. Debra Bingham from the California Maternal Quality Care Collaborative at Stanford have been instrumental in helping define the boundaries of this ECR along with what would be considered potentially avoidable complication (PAC) in the setting of a nulliparous, singleton, term, vertex pregnancy. The patterns of obesity care research team at the Johns Hopkins University (lead by Jonathan Weiner) helped us develop the Bariatric Surgery codesets, and the physicians from Minnesota Gastroenterology, a large single specialty GI practice in the Twin Cities of Minnesota have been helping us develop the GERD (gastro-esophageal reflux disease) ECR.
The SAS packages produce a severity-adjusted case rate for members qualifying for a given ECR. Additionally, the outputs from the SAS program help users understand the amount of waste in the form of PACs in their database and realize the opportunities for savings. The SAS packages also help users understand what the most important PACs are and the costs associated with them. By linking these outputs to the responsible providers, their data could become actionable.
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Health Plan Highlight: Blue Cross and Blue Shield of North Carolina Expands Bridges to Excellence Program
Three years ago, BCBS of North Carolina implemented a Bridges to Excellence (BTE) pilot with 194 physicians representing 41 practices. Physicians were rewarded for demonstrating good patient outcomes in diabetes and cardiac care as well as implementing and using electronic systems to manage their patient population. BCBSNC recently concluded an evaluation of the pilot and consider it a success.
Blue Cross of North Carolina analyzed claims from the pilot period and found that:
- Practices that achieved Physician Office Link recognition had patients that were 34 percent less likely to visit the ER and 24 percent less likely to see a specialist. Patients were also 12 percent less likely to receive costly and unnecessary radiology services.
- Physicians that achieved Diabetes Care Link recognition had patients that were much more likely to have blood pressure under control.
"We've believed for years that quality improvement leads to better health outcomes and lower costs, and now we have the data that demonstrate it. Our investment in Bridges to Excellence over the past three years has made a difference for patients and physicians" said Dr. Don Bradley, BCBSNC Senior Vice President and Chief Medical Officer.
As a result of the success, BCBSNC is considering ways to expand the Bridges to Excellence program across a broader set of physicians within their network. In a recent Herald-Sun interview, Bob Greczyn, President and CEO of BCBSNC, indicated that Bridges to Excellence plays an important role in controlling costs and health care reform, in that providers should be rewarded on the basis of helping patients improve their health and not based on the number of procedures they perform.
An announcement with the details is expected before the end of the year.
Quote obtained from Business Leader Magazine, July 2009.
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Physician Performance Assessment Highlight: CINA & BTE-Easing the Burden of Data Submissions for Quality Assessment
While some EMR vendors are working hard to make it easy for their users to submit quality and performance data to Bridges to Excellence (BTE), many EMR vendors are simply not devoting the resources necessary to do this. Even those vendors who are developing the tools to assist their users must deal with a number of significant challenges. One of the major challenges early adopters of EMRs have encountered is the variability in how data was entered into their system. Most EMRs have traditionally allowed a great deal of flexibility in how the system was actually used. Often the step of developing processes for consistent use of their EMRs by everyone in the practice was never done. Consequently, the same data element may be stored in multiple ways, and in multiple locations within the EMR. This can produce a significant challenge in extracting data across multiple providers.
CINA provides an alternative for BTE participation for providers using an EMR that can't easily summarize and submit data for quality assessment. As a company focused on helping providers improve the quality of care they deliver, CINA has developed tools to locate, abstract, standardize, encode, and store selected data into a separate industry-standard database, or Clinical Data Repository (CDR), located at the practice level. Once a practice has all its relevant historical data in a standardized CDR, the data can easily be used for clinical decision support, patient registries, benchmarking, analysis and performance reporting to quality measurement organizations such as BTE. The processes of importing data into the standardized CDR, as well as extracting, aggregating and submitting data to third parties is automated, allowing physicians to regularly report to BTE with little effort on their part and focus attention on areas in which they are performing well and those which need improvement.
For more information on BTE's automated performance assessment process and a list of all vendors working with BTE, please visit our website. |
| PROMETHEUS Implementation
PROMETHEUS Payment Summit Held at Rockford, IL Pilot Site
On September 10, 2009, BTE staff were on hand to take part in a PROMETHEUS Summit at the Rockford, IL pilot site. The Summit's goal was to educate members and partners of the Employers' Coalition on Health (ECOH) as well as community stakeholders about the pilot and the payment implications effective January 1, 2010. Separate sessions targeted ECOH Member employers, their Third Party Administrators, their broker/consultants, and representatives from the local health systems.
The day before the Summit, the local paper, the Rockford Register Star had carried a story about the program and its national implications. Special attention focused on Rockford's role in this national effort, and that it was chosen as a pilot site because it shares many aspects with communities throughout the United States. As such, a successful pilot in Rockford would be able to be replicated nationwide.
The final session of the Summit was to educate ECOH Members and partners on the mechanics of the pilot, including introducing them to the "shared savings" approach to provider reimbursement. "Shared savings" will be used in year one of the pilot, as a step toward the bundled payment goal of PROMETHEUS Payment and will pertain to three ECRs: Diabetes, Hypertension, and CAD.
ECOH continues to work on reporting, implementation with the local health systems, and education efforts with its members.
For more information on PROMETHEUS Payment click here. | |
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© 2003-2009 Bridges to Excellence, Inc. All rights reserved.
Bridges to Excellence does not endorse any particular product or service or any physician or physician group. Bridges to Excellence relies on third-party performance assessment organizations such as the NCQA and Quality Improvement Organizations to measure a physician or physician's group performance and ability to demonstrate that they meet certain measures of quality care.
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