Consumer Incentives in Disease Management: The Bridges to Excellence Model

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Disease Management Colloquium June 23, 2005 Lynn A. Kohrs General Electric Co., Inc. Consumer Incentives in Disease Management: The Bridges to Excellence Model. - PowerPoint PPT Presentation

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  • Consumer Incentives in Disease Management:The Bridges to Excellence Model

    Disease Management ColloquiumJune 23, 2005

    Lynn A. KohrsGeneral 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 conditionsFocus:Reengineer 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 diseases

  • BTE uses standard nationally recognized measures of performanceStructure (PPC):Process & Outcomes (DPRP & HSRP):HbA1Cs tested and controlledLDLs tested and controlledBP tested and controlledEye, Foot and Urine examsLDLs tested and controlledBP tested and controlledUse of aspirinSmoking cessation advicePatient safety e-prescribingGuideline-driven care EHRsFocus on high-cost patients Care coordinationImproved compliance Patient education & support

  • There are three programs based on the NCQA Physician Recognition Measures

  • Weve Made Great Progress in Our Pilot MarketsBridges To Excellence, Proprietary & Confidential1,896Diabetes Care$8MMAvailable Rewards$1.4MRewards paid to-dateOffice SystemsEmployees going to recognized PhysiciansDiabetes CareOffice Systems6055930Physicians Recognized for ExcellenceDec 2004Jan 2004Diabetes Care$8MMAvailable RewardsRewards paid to-date8,872Office SystemsEmployees going to recognized PhysiciansDiabetes CareOffice Systems3816030Physicians Recognized for ExcellenceMar 2005Jan 2004

  • Additional Interest In Nearly 30 MarketsAll ProgramsDCLPOLCCLTBDLHRP

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

    Chart3

    16201400

    Non-recognized Physicians

    Recognized Physicians

    Sheet1

    Non-recognized PhysiciansRecognized Physicians

    Diabetes Costs Only$1,620$1,400-0.1571428571

    -0.0545454545

    Non-recognized PhysiciansRecognized Physicians

    All Costs$5,800$5,500

    Sheet1

    Non-recognized Physicians

    Recognized Physicians

    Sheet2

    Non-recognized Physicians

    Recognized Physicians

    Sheet3

    Chart4

    58005500

    Non-recognized Physicians

    Recognized Physicians

    Sheet1

    Non-recognized PhysiciansRecognized Physicians

    Diabetes Costs Only$1,620$1,400-0.1571428571

    -0.0545454545

    Non-recognized PhysiciansRecognized Physicians

    All Costs$5,800$5,500

    Sheet1

    Non-recognized Physicians

    Recognized Physicians

    Sheet2

    Non-recognized Physicians

    Recognized Physicians

    Sheet3

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

    Chart1

    185188

    563501

    140133

    Non-Recognized

    Recognized

    Sheet1

    Non-RecognizedRecognized

    Family Medicine$185$188-2%

    Ob/Gyn$563$50111%

    Pediatrics$140$1335%

    Non-RecognizedRecognized

    All PCPs$216$18913%

    Sheet1

    00

    00

    00

    Non-Recognized

    Recognized

    Sheet2

    00

    Non-Recognized

    Recognized

    Sheet3

    Chart2

    216189

    Non-Recognized

    Recognized

    Sheet1

    Non-RecognizedRecognized

    Family Medicine$185$188-2%

    Ob/Gyn$563$50111%

    Pediatrics$140$1335%

    Non-RecognizedRecognized

    All PCPs$216$18913%

    Sheet1

    00

    00

    00

    Non-Recognized

    Recognized

    Sheet2

    00

    Non-Recognized

    Recognized

    Sheet3

  • Rewarding Active Consumers: CareRewardsFour-step processCreate a profile to establish baselineUse CareGuide with doctor to set long term goalsUse CareJournal to track progressEarn CareRewards by answering the self-care questionsBridges To Excellence, Proprietary & ConfidentialLinks to:MD search to find recognized MDsLeapfrog Website for hospital safety dataNewsletters, news, clinical trials and additional health infoEmployer specific content

  • CareRewardsParticipant 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 diabetesPatient 1RequirementsPoints EarnedCompletes all of the self-care processes for six months4,000Patient 2Completes all of the self-care processes for six months and reduces HbA1c 1%9,000Patient 3Completes all of the self-care processes for 1 year and reduces HbA1c 2%17,000Bridges To Excellence, Proprietary & Confidential

  • Physician Quality Ratings: Rating and RankHigh-level roll-up of physicians overall performanceDistinguishes relative performance of physicians within each levelPatients can express satisfaction or dissatisfaction about their primary physicianBridges To Excellence, Proprietary & Confidential.

  • Continue building programs to cover most specialties200720062005PPC version 2.0 +All DocsPCPs (IM, FP, Gyn, Ped, etc.)PCP Recognition ProgramPatient Experience of CareOrtho & RheumMSK RPOncologistsCancer RPEndoDPRPCardio & NeuroHSRP

  • Efforts have been incorporated in other national initiativesHRPA 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 themCMS were working with CMS on three of its demos: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched upHealth Plans UHC has licensed BTE for their customers, along with CIGNA, CareFirst BCBS and NBCH

  • For More informationWeb site: www.bridgestoexcellence.orgNewsletter: 1-800-224-7161Contact: Jessica DiLorenzo, General Electric jessica.dilorenzo@corporate.ge.com

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