Bridges To Excellence

Citizen’s Health Care Working GroupBoston, Massachusetts

August 17, 2005

Jeffrey R. Hanson, MPHRegional Health Care Manager, Verizon Communications

President, Bridges to ExcellenceBoard Member, Leapfrog Group

Page 2

BTE

We created a multi-stakeholder group and designed the program to meet diverse needs

Mission: Improve care quality through rewards and incentives that

• (1) encourage providers to deliver optimal care, and

• (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 cardio-vascular diseases

Page 3

BTE

We’re a not-for-profit company with a Board and a Leadership Council

BTE Participants & Licensees: Dale Whitney – 2 years Jeff Hanson – 3 years Francois de Brantes – 3 years Vince Kerr – 2 years Renee Turner Bailey (through 12-31-2005)

Martin Sepulveda (as of 01-01-2006) – 2 years

Other Stakeholders: Suzanne Delbanco – 3 years Tom Lee – 3 years George Isham – 2 years Andy Webber – 2 years

BTE Executive Committee:Jeff Hanson, PresidentDale Whitney, SecretaryFrancois de Brantes, Treasurer

Board

Purpose: Provide broad governance from all BTE stakeholders, issues debating council & working group for Board

Participants: Employers (including each GE Business + GH), Plan Licensees, Allied organizations

Leadership Council

Page 4

BTE

We have three programs that are operational now

NCQA Measure set

Physician Activation

Consumer Activation

Physician Office Link (POL)

Physician Practice Connections (PPC)

Up to $50 pmpy Physician-level report card, and patient experience of care survey

Diabetes Care Link (DCL)

Diabetes Provider Recognition Program (DPRP)

Up to $100 pdppy Diabetes care management tool, and rewards for care compliance

Cardiac Care Link (CCL)

Heart Stroke Recognition Program (HSRP)

Up to $160 pcppy Cardiac care management tool, and rewards for care compliance

Page 5

BTE

We’re building programs to cover most specialties

200720062005

PPC version 2.0 +All Docs

PCPs (IM, FP, Gyn, Ped, etc.)

PCP Recognition Program

Patient Experience of Care

Ortho & Rheum MSK RP

Oncologists Cancer RP

Endo DPRP

Cardio & Neuro HSRP

Page 6

BTE

We’ve made great progress in all our pilot markets already

Jan 2004 July 2005

Recognized Physicians

PPC 30 669

DPRP 60 384

HSRP 0 29

Employees going to recognized Physicians

DPRP 1,865

PPC 12,668

Rewards paid to-date $1,875K

Available Rewards $8,000K

Page 7

BTE

We’re continuing a rigorous evaluation, but we’ve learned a lot

What we know: DPRP docs are more efficient, by 10% - 15% when

looking at diabetes costs alone, by 5% when looking at overall costs

• The average gross savings per patient is about $250 per year

POL docs are more efficient, by 5% to 10% when looking at total costs of care

• The average gross savings per patient is about

What we don’t know: Are DPRP & POL docs more efficient over time? We’re

also getting the answer from two sources:• Ingenix & Mercer

Page 8

BTE

DPRP recognized physicians are more efficient and have lower variation in costs

$1,250

$1,300

$1,350

$1,400

$1,450

$1,500

$1,550

$1,600

$1,650

Diabetes Costs Only

Non-recognized Physicians Recognized Physicians

$5,350

$5,400

$5,450

$5,500

$5,550

$5,600

$5,650

$5,700

$5,750

$5,800

All Costs

Non-recognized Physicians Recognized Physicians

Page 9

BTE

POL Recognized PCPs as a group are more efficient, especially Ob-Gyns

$-

$100

$200

$300

$400

$500

$600

Family Medicine Ob/Gyn Pediatrics

Non-Recognized Recognized

$170

$180

$190

$200

$210

$220

All PCPs

Non-Recognized Recognized

Page 10

BTE

The Louisville market has yielded many lessons that can help youAt launch: 4 recognized physicians, today 36

The Challenge: Physician Philosophy – driven regionally Outside of Norton Healthcare, physicians are not organized into

large practices/systems, limited resources Single product market – 63k lives = 3500 diabetics

The Lessons: Need both a push and pull approach Basic outreach & follow up increased patient % from 4% to 13% Extraction services supported by grants has increased pipeline

to 20-30 physicians for DPRP Public support from multiple sources – all pushing for the same

thing Physicians are learning what constitutes guideline care and

receiving the tools to support it in lieu of EMR to get them there Patients need to get in the game through incentives

Page 11

BTE

Lessons Learned in each market will help us in all future markets

Louisville – small independent practices need a lot of hand holding to get them over the hump…even when they have a lot of rewards at stake.

Cincinnati – using third party chart extractors is a powerful way to reduce barriers to reporting. Grant funding is available for that process.

Boston – engaging large groups and “training the trainer” is critical to getting rapid program uptake.

Albany – most IPAs, even smaller ones, are eager to adopt standard processes and welcome the business case that this program brings them to convince their members to make the needed investments.

Page 12

BTE

Consumers are engaged through our report card web site

High-level roll-up of physician’s overall performance Distinguishes relative performance of physicians within

each level

Bridges To Excellence, Proprietary & Confidential

Page 13

BTE

Effectiveness results come from NCQA, & patient experience of care from employees

Bridges To Excellence, Proprietary & Confidential

Page 14

BTE

Consumers are also engaged through WebMD

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

Bridges To Excellence, Proprietary & Confidential

Page 15

BTE

We now have three plan licensees and a strong alliance with NBCH

Health Plans: UHG – United Health Group has up to ten markets it is focused

on, including Omaha, South Florida, Central Florida, St. Louis, Dayton

CareFirst BCBS – will be rolling out POL on a limited basis CIGNA – has committed to implementing BTE in AZ, NC and

parts of TX

NBCH – There are currently four coalition markets ready to start one or more BTE programs

Heartland Healthcare (IL) Tri-State Health Care (IL/MO/IA) Employer’s Health Coalition (AR) Colorado Business Group on Health

Page 16

BTE

All Programs (DCL/POL/CCL)

DCL

POL

CCL

TBD

LHRP

Current BTE Markets

Interested Markets:

Additional Interest In Over 30 Markets

Page 17

BTE

Our efforts have been incorporated in other national initiatives

CMS – we’re working with CMS on three of its programs: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched BTE and CMS will be jointly implementing incentives in

MA and Arkansas (through a local NBCH coalition), and possibly Utah

Human Resources Policy Association (HRPA) and Care Focused Purchasing (CFP) HRPA has two initiatives – National Affordable &

Regional – that are tied to BTE (& Leapfrog) by linking up with plans that use/promote BTE programs.

CFP has also agreed to use BTE Program measures in how they evaluate high-performing physicians

Page 18

BTE

Contacts and Additional InformationAdditional program information: www.bridgestoexcellence.org

Specific questions on regional roll out and BTE programs: bridgestoexcellence@thomson.com