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Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional Healthcare Manager, Verizon Communications Board President, Bridges to Excellence HIT Summit West San Francisco, CA March 8, 2005

Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

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Page 1: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Bridges To ExcellenceRewarding Quality

Accelerating IT Adoption in Healthcare

Jeff Hanson, MPHRegional Healthcare Manager, Verizon Communications

Board President, Bridges to Excellence

HIT Summit West

San Francisco, CA

March 8, 2005

Page 2: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

AGENDA

• Quality Imperative – Employer’s View• Program Structure• Results• Consumer Engagement• Lessons Learned

Page 3: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Employer Perspective: “Change is Necessary”

• Compelling Stats280,000 people will get the wrong advice today in a

doctor’s office2,800 people will be harmed today by a medication errorEquivalent of 390 fully-loaded 747’s will die this year in

the hospital from a preventable medical mistake – >1 747/day

Many of these will be our employees

Page 4: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

What Problems are we Trying to Solve?

Big Gap Between “What we Know” and “What We Do”American adults, on average, receive the healthcare

recommended for their conditions only 54.9% of the time

Nearly one-third of patients with congestive heart failure are discharged from the hospital without being given ACE inhibitors, even though it’s been known for a decade that these drugs provide life-saving benefits

Translation of medical research into practice is slow—average of 17 years

Page 5: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Quality: Missing the Mark

Source: NEJM 2003 348:2635-45

Page 6: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Employer Perspective – Potential for Cost Savings

0% 5% 10% 15% 20%

Potential savings using best practices

18%Efficient Providers

16%Effective Providers

4%Plan Administration

Plan Design 7%

The Business Roundtable and William M. Mercer, 2002

0% 5% 10% 15% 20%

Potential savings using best practices

18%Efficient Providers

16%Effective Providers

4%Plan Administration

Plan Design 7%

18%Efficient Providers 18%Efficient Providers

16%Effective Providers 16%Effective Providers

4%Plan Administration 4%Plan Administration

Plan Design 7%Plan Design 7%

The Business Roundtable and William M. Mercer, 2002Time to change focus …without losing sight of

reality

Page 7: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Employer Perspective: Improved Effectiveness Leads to Cost Savings

Incentives

$

Greater Effectiveness

HealthierPatients

Cost Savings

Preventive Screening

Disease Management

Clinical Information Systems

Fewer Complications

Fewer Medical Errors

Reduced Health Care Costs

Increased Productivity

Page 8: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

WASHINGTON - The Bridges to Excellence (BTE) coalition, a group of large employers that collectively support various physician pay-for-performance efforts around the country, today announced its largest bonus payout to date: more than $800,000 to 35 medical groups in the Boston area. The incentive payments reward physician practices that have implemented systems and which leverage available information technology to track and educate patients, maintain medical records, prescribe medicines and ensure appropriate follow up. Such systems have been shown to dramatically improve patient care and prevent mistakes.

December 3, 2004

Page 9: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Multi-stakeholder approach to creating incentives for qualityEmployers, health plans, consumers, physicians and group practices

Mission: Improve quality of care through rewards and incentives that

encourage providers to deliver optimal care, and encourage patients to seek evidence-based care and self-manage their conditions

Focus:Re-engineer office practices by adopting better systems of careDemonstrate the reengineering is working through better outcomes for patients with chronic conditions, starting with diabetes and cardio-vascular diseasesProgram costs paid by participating employers

BTE – What is Bridges To Excellence?

Page 10: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE: Rewarding Outpatient Care

Bridges to Excellence is a program designed to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care.

Quality is measured uniformly using nationally accepted standards, collected by an independent third party – NCQA

Quality measures are focused on actuarially sound performance criteria that provide an opportunity for a positive ROI for payers in a fee-for-service environment

What we’re after is a significant reengineering in the processes of care.

Page 11: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE: Overall Concept

Employers CommitWithin Market

• Collaboration

• Critical Mass

Health PlansSupply Data

• Patient Counts per Physician

PhysiciansNotified

• Reward Potential

• Next Steps

PracticesApply

• NCQA Web site

• Application Fees

PracticesRecognized

• NCQA

• 3-yr

PracticesRewarded

• Rewards Based on Patient Counts

• Fees Reimbursed

Page 12: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE uses nationally recognized physician recognition programs

Structure (PPC):

Process & Outcomes (DPRP & HSRP):

HbA1Cs tested and controlledLDLs tested and controlledBP tested and controlledEye, Foot and Urine exams

LDLs tested and controlledBP tested and controlledUse of aspirinSmoking cessation advice

Patient safety – e-prescribingGuideline-driven care – EHRsFocus on high-cost patients – Care coordinationImproved compliance – Patient education & support

NCQA

Page 13: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

The process for recognition and rewards is straightforward

• Physicians apply for recognition with NCQA• NCQA send notify of physician being

recognized to Medstat

• Medstat looks up physician/patient attribution by BTE Participant & Invoices for rewards

• BTE Participant pays reward to Medstat

• Medstat bundles Participant payments and pays physician

Page 14: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

PPC – HIT Adoption

PPC identifies and highlights doctors and medical groups that use information and systems to make patient care better. Patient registries, online prescribing and electronic medical records are among the many processes that may qualify for recognition and, in some cases, rewards.

Page 15: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

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 16: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Summary of Performance Measures

Clinical Information Systems Patient Education and Support Care Management

Use of Patient Registries Educational Resources (languages) Care of Chronic Conditions (disease management)

Electronic RX and Test ordering systems

Referrals for Risk Factors & Chronic Conditions

Preventable Admissions

Electronic Medical Records Quality Measurement and Improvement Care of High-Risk Medical Conditions (care management)

Diabetes Care Link Measures

Req. % of Patients Achieving Measure

# Tested HbA1c 93%

Proportion HbA1c < 7% 40%

Proportion HbA1c > 9.0% 20%

# Eye exams 60%

# Foot Exam 80%

# Blood Pressure Frequency 97%

Proportion < 140/90 mm Hg 65%

# Nephropathy Assessments 80%

# Lipid Profiles 85%

LDL <130 mg/dl 63%

LDL <100 mg/dl 36%

Smoking Status/Cessation Cnsl. 80%

80%# Lipid Profiles Done in last 12 mos

50%LDL <100 mg/dl

80%Patients with aspirin or other antithrombotics use

80%Smoking status & cessation advice

75%Proportion < 140/90 mm Hg

80%# Blood Pressure Testing in last 12 mos

Req. % of Patients

Achieving Measure

Cardiac Care Link Measures

Physician Office Link (PPC) Measures

Page 17: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE IncentivesOffices meeting Passing Score in:

POL DCL/CCL

Clinical Information

System

Patient Education &

Support

Care Management

Any Module

Y1 $50 20% of bonus is withheld until

practice meets DCL and/or CCL (depends on

whether attribution id’s diabetics and/or

cardiac patients)

Doc gets full POL bonus plus extra

$80 for each diabetic and cardiac

patient when meeting CCL/DCL

Y2 $20

Y3 $10

Two out of three Modules

Y1 $50

Y2 $50

Y3 $30

All three Modules

Y1 $50

Y2 $50

Y3 $50

A top scoring practice can earn up to $20K per doc/year

Page 18: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

The rewards are designed to encourage adoption AND use of better systems 3 PCP Practice with 1000 patients covered

by the program:3.5% are diabetic patients2.5% are cardiac patients

Practice receives total of $54,800:$40 * 1000 = $40,000 for meeting PPC measures

(POL)$80 * 60 + $10 * 1000 = $14,800 for meeting

DPRP & HSRP measures (DCL & CCL) Purchaser saves a total of $55,000 less

program costs ($6 pmpy)

Page 19: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE is live in four markets

Cincinnati, OH /Louisville, KY

Boston, MAAlbany /

Schenectady, NY

Launch Date June 2003 February 2004 May 2004

Program(s) DCL DCL, POL POL, DCL, CCL

# of Employers

7: GE, Ford, UPS, P&G, Humana, CCHMC, City of Cinci

3 (6): GE, Raytheon, Verizon, (IBM, AZ)

4: GE, Hannaford Bros, Verizon, Golub

# of Plans6: Humana, Aetna,

UHC, Anthem, BCBS (OH, AL)

5: Tufts, Harvard, UHC, BCBS(MA, AL),

3: MVP, CDPHP, UHC

# of Covered Lives

200,000(7,000 Diabetes)

85,000(3,500 Diabetes)

45,000(2,000 Diabetes; 1,000 Cardiac)

Page 20: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

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

Jan 2004 Jan 2005

Recognized

Physicians

PPC 30 475

DPRP 60 361

Employees going to recognized Physicians

DPRP 1,742

PPC 8,872

Rewards paid to-date $1.07M

Available Rewards $8MM

Page 21: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Results to Date

CUMULATIVE

BTE Recognized & Rewarded Physicians DCL POL CCL

Market Recg Rwd Recg Rwd Recg Rwd

Cincinnati 65 63 Louisville 27 26 Boston 233 96 465 447 NY Capital Region 36 7 10 10 0 0 Total 361 192 475 457 0 0

BTE Bonus Earned Market DCL POL CCL Total Cincinnati $98,615 $98,615 Louisville $96,955 $96,955 Boston $45,832.32 $759,278.53 $805,110.85 NY Capital Region $7,040 $61,320 $0 $7,040 Total $248,442.32 $820,598.53 $0 $1,007,720.85

Employer Patients Seeing NCQA Recognized Physicians

DCL POL CCL Cincinnati # Elig. % # Elig. % # Elig. % Cincinnati 924 5405 17.5% Louisville 342 3767 9.1% Boston 411 3664 11.2% 8043 86297 9.3% NY Capital Region 65 2093 3.1% 829 43585 1.9% 0 968 0.0.% Total 1742 14929 11.7% 8872 129882 6.8% 0 968 0.0.%

Page 22: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

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

• What we know:– DPRP docs are more efficient, by ~15% when

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

• What we don’t know:– Are POL docs more efficient? We’re getting the

answer from two sources:• Ingenix working with Tufts• CFP since they have aggregated data in MA

– Are DPRP docs more efficient over time? We’re also getting the answer from two sources:

• Ingenix & CFP

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Bridges To Excellence, Proprietary & Confidential

And they also have lower costs of care, whether episodes or total 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 24: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Why BTE – Employer Perspective

Financial DPRP savings est. 15% or ~$1,000 pppy (medical only) ROI >10% members see DPRP doctors Verizon – est. 50,000 diabetic members 5,000 x $1000 = $5M annual savings (breakeven) If 50% DPRP, savings = $25M annually (medical only) If 100% DPRP, savings = $50M annually (medical only)Quality Quality does not mean higher cost Realign provider incentives HIT adoption; implications beyond diabetes

Page 25: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Rewarding Active Consumers: CareRewards

•Four-step processCreate 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

Links to:• MD search to find recognized MD’s• Leapfrog Website for hospital safety data• Newsletters, news, clinical trials and additional health info

Employer specific content

Page 26: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Earning and Redeeming Points

Bridges To Excellence, Proprietary & Confidential

Rewards Customizable by Employer

Page 27: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Consumers are also engaged through our physician 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 28: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

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

Bridges To Excellence, Proprietary & Confidential

NCQA
Let's drop this one. Still has the percents in it, which are not reported, & the actual reports will probably look quite different.
Page 29: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Lessons Learned/Challenges/Opportunities Provider report cards are disliked by almost all providers

BTE’s stance has been to tie incentives to public disclosure of performance measures using tested tools

Providers are emphatic that patient incentives be aligned with provider incentives Having the Diabetes/Cardiac Care Rewards program has been a

significant contribution to the positive feedback by providers regarding BTE

Employer communications to employees and other covered members is critical to success of initiatives But employers need plug & play toolkits to implement the campaigns

Engaging consumers adds complexity to an already complex program Need to source vendors, create specs and test consumer tools in

addition to setting up all processes and operations on provider performance measures and rewards

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Bridges To Excellence, Proprietary & Confidential

Key lessons learned are applied to all markets to improve performance

Moving docs to reengineer faces numerous barriers – cost, privacy, interoperability – all surmountable

Physician certification process is resource intensive Getting multiple purchasers to coordinate activities

is tough, especially when they are used to plans doing everything for them

You have to be nimble and quick to adapt to succeed in changing the market

Page 31: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Program Success Factors

Critical mass re: employer participation (covered lives) in specific markets

Active employer and health plan participation in each market

Prompt execution of data agreementsBuy-in by physician community

Bridges To Excellence, Proprietary & Confidential

Page 32: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

BTE Markets

BTE Interest

•4 UHC markets

•2 Employer specific

•3 BCBS Plans

•Remainder – Coalition based

There are 13 additional markets that have actively expressed interest in BTE

Page 33: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

Market expansion & strategic alliances

• Plan Licensing: BTE & UHG – initially 10 markets including Omaha, South

& Central Florida, St. Louis CareFirst BCBS rolling out POL 1/18/2005

• CMS: MCMP demonstration program set to be launched, with

first cooperative market being MA• Leapfrog:

BTE & Leapfrog can cooperate to help regional coalitions implement the new Leapfrog Hospital Rewards Program

• NBCH: Currently four coalition members ready to start one or

more BTE programs

Page 34: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

We need to add critical clinical areas every year to get to the bulk of our spend

2005 2006 2007

Inpatient

(Leapfrog)

CABG, AMI, PCI, Pneu, Delivery

Ortho, GI Oncology

Outpatient

(BTE)

Diabetes, cardiac

Internal Med (incl Gyn, Ped), Ortho

Oncology

% of Total Commercial Spend

25% 45% 60%

Page 35: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & Confidential

We’re going to continue building programs to cover most specialties

•2007•2006•2005PPC 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 36: Bridges To Excellence, Proprietary & Confidential Bridges To Excellence Rewarding Quality Accelerating IT Adoption in Healthcare Jeff Hanson, MPH Regional

Bridges To Excellence, Proprietary & ConfidentialBridges To Excellence, Proprietary & Confidential

Focused on physician care reengineering Processes of care that are assessed include health information technology (i.e. fully functional & interoperable EHR), patient education and care management Program launched and operated in four markets. Health information technology being rewarded now in two markets (MA & NY) NCQA assesses if practices meet the BTE criteria through the PPC program, which is being revised into Version 2.0, adding in MCMP requirements

BTE Summary

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Bridges To Excellence, Proprietary & Confidential

Resources

Bridges to Excellence.

www.bridgestoexcellence.org National Committee for Quality

Assurance.

www.ncqa.org The MEDSTAT Group.

[email protected] MD.

www.webmdhealth.com National Business Coalition on Health

www.nbch.org