Consumer Incentives in Disease Management: The Bridges to Excellence Model Disease Management Colloquium une 23, 2005 Lynn A. Kohrs General Electric Co., Inc. Bridges to Excellence is a multi-stakeholder approach to creating incentives for quality that engages employers, health plans, physicians, and consumers. Mission: > Improve quality of care through rewards and incentives that (1) encourage providers to deliver optimal care (2) encourage patients to seek evidence-based care and self-manage their own conditions Focus: > Reengineer office practices by adopting better systems of care > Demonstrate the reengineering is working through better outcomes for patients with chronic conditions, starting with diabetes and cardiovascular diseases
BTE uses standard nationally recognized measures of performance Structure (PPC): Patient safety e-prescribing Guideline-driven care EHRs Focus on high-cost patients Care coordination Improved compliance Patient education & support NCQA rocess & Outcomes (DPRP & HSRP): HbA1Cs tested and controlled LDLs tested and controlled BP tested and controlled Eye, Foot and Urine exams LDLs tested and controlled BP tested and controlled Use of aspirin Smoking cessation advice There are three programs based on the NCQA Physician Recognition Measures
Physician Office Link (POL) NCQA Measure set Physician Activation Consumer Activation Physician Practice Connections (PPC) Up to $50 pmpy Physician-level report card, and patient experience of care survey Diabetes Care Diabetes Provider Up to $100 pdppy Recognition
Link (DCL) Program (DPRP) Cardiac Care Link (CCL) Heart Stroke Recognition Program (HSRP) Diabetes care management tool, and rewards for care compliance Up to $160 pcppy Cardiac care management tool, and rewards for care compliance Weve Made Great Progress in Our Pilot Markets Physicians Recognized for Excellence
Jan 2004 Mar Dec2005 2004 Office Systems 30 559 Diabetes Care 60 381 Office Systems 8,872 Diabetes Care 1,896
Employees going to recognized Physicians Rewards paid to-date Available Rewards Bridges To Excellence, Proprietary & Confidential $1.4M $8MM Additional Interest In Nearly 30 Markets Current BTE Markets) InterestedMarkets: All Programs DCL POL CCL TBD LHRP DPRP recognized physicians are more efficient and have lower variation in costs
$5,450 $1,300 $5,400 $5,350 $1,250 Diabetes Costs Only Non-recognized Physicians Recognized Physicians All Costs Non-recognized Physicians Recognized Physicians POL Recognized PCPs as a group are more efficient, especially Ob-Gyns $600 $500 $220
$400 $210 $300 $200 $200 $190 $100 $180 $- Family Medicine Ob/Gyn Non-Recognized Recognized Pediatrics
$170 All PCPs Non-Recognized Recognized Rewarding Active Consumers: CareRewards Employer specific content Links to: MD search to find recognized MDs Leapfrog Website for hospital safety data Newsletters, news, clinical trials and additional health info Bridges To Excellence, Proprietary & Confidential Four-step process > Create a profile to establish baseline > Use CareGuide with doctor to set long term goals
> Use CareJournal to track progress > Earn CareRewards by answering the self-care questions CareRewards > Participant accumulates points through improving self care processes and outcomes (HbA1c) > Participant redeems points for coupons towards purchases at Diabetic Express for lifestyle products: sugar free foods, monitoring software, books on living with diabetes Requirements Points Earned Patient 1 Completes all of the self-care processes for six months 4,000
Patient 2 Completes all of the self-care processes for six months and reduces HbA1c 1% 9,000 Patient 3 Completes all of the self-care processes for 1 year and reduces HbA1c 2% 17,000 Bridges To Excellence, Proprietary & Confidential Physician Quality Ratings: Rating and Rank > High-level roll-up of physicians overall performance > Distinguishes relative performance of physicians within each level > Patients can express satisfaction or dissatisfaction about their primary physician
. Bridges To Excellence, Proprietary & Confidential Continue building programs to cover most specialties 2005 All Docs PCPs (IM, FP, Gyn, Ped, etc.) 2006 PPC version 2.0 + Patient Experience of Care PCP Recognition Program Endo DPRP Cardio & Neuro HSRP Ortho & Rheum Oncologists
2007 MSK RP Cancer RP Efforts have been incorporated in other national initiatives HRPA the coalition has agreed to use the BTE & Leapfrog-defined measure sets in its initiative, and will only contract with plans that agree to use them CMS were working with CMS on three of its demos: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched up Health Plans UHC has licensed BTE for their customers, along with CIGNA, CareFirst BCBS and NBCH For More information Web site: www.bridgestoexcellence.org Newsletter: 1-800-224-7161 Contact: > Jessica DiLorenzo, General Electric [email protected]
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