Robert S. Galvin, MD Director, Global Healthcare and Medical Services, General Electric, Co.
Chuck Haas, Manager, City of Cincinnati
Erica W. Cunningham, Sr. Staff Consultant, Corporate Benefits, Verizon Human Resources
Robert S. Galvin, MD Director, Global Healthcare and Medical Services, General Electric, Co.- In our current payment system, improving quality particularly decreasing over-use results in diminished income for physicians. That’s why the Institute of Medicine, in its series on the Quality of Health Care in America, called for bold payment reform to facilitate quality improvement.
One of BTE’s key contributions is its use of “Recognition” programs as the basis for rewards. These programs address the “n” problem (i.e., the fact that small sample sizes can lead to inaccurate rankings), both by using multiple measures per condition, and by establishing a statistically determined minimum number of encounters. Also, by using “intermediate outcome” measures rather than pure process metrics, Recognition programs represent a true advance in measuring physician performance.
Collective action by purchasers and payers is THE rate-limiting step in creating effective, new payment programs. Due to the disaggregated nature of the private sector, multiple payers are needed for incentives to be large enough to drive change.
The “big picture” around BTE is that our health care system continues to demonstrate an impressive capacity to innovate. The positive aspect of having robust private sector involvement on the financing side of health care is that smart people from outside the core health sector are motivated to generate creative solutions to our toughest challenges. There is a “hidden dynamic” between the private and public sectors, in which the greater flexibility of the former can lead to new ideas that the power of the latter can institute. We have recently seen this phenomenon with performance measurement and public transparency (e.g. the Leapfrog Group), and I believe Bridges to Excellence is playing a similar role on the payment reform side. For the sake of our system and its patients, let’s hope so.
Chuck Haas, Manager, City of Cincinnati: “It is imperative that more payers engage in pay-for-performance efforts and continue to push for the adoption of these principles.”- The City of Cincinnati began participating in the Bridges To Excellence Diabetes Care Link in March, 2004. Four years later, the City continues to participate in and support the program. The results of BTE studies to date have been encouraging. The City’s analysis of its own data demonstrates that the cost of care provided by BTE recognized physicians is significantly less than non-recognized physicians.
Credit should be given to the core group of employers that launched and supported the program through the developmental years, including the Ford Motor Co., GE, P&G, UPS, Humana, Cincinnati Children’s Hospital and the City of Cincinnati. Much has been learned as a result of these companies’ initial investments, leading to an efficient and cost-effective program that other area employers can join at minimal costs.
The City will continue to support BTE initiatives, and is hoping that additional BTE programs (i.e., Physician Office Link and Cardiac Care Link) can be implemented soon in this market. It is imperative that more payers engage in pay-for-performance efforts, and continue to push for the adoption of these principles in provider compensation strategies for both their self-insured and fully-insured customers. As more employers and insurance plans adopt the P4P strategy, we expect to see significant numbers of providers seeking recognition from BTE or other accredited programs to qualify for additional compensation.
Erica W. Cunningham, Sr. Staff Consultant, Corporate Benefits, Verizon Human Resources: BTE’s efforts to support transformation: “A step in the right direction to help change and advance our healthcare system.”- As a founding member of Bridges to Excellence and former Board member, Verizon supports the pay-for-performance model for healthcare providers.
During the past five years, the P4P landscape has changed dramatically. We believe BTE’s visionary stance on the need to reform the payment model for physicians has contributed to this change. We have seen a shift in the efforts of our major health plan administrators to implement the BTE model, or incorporate their own criteria around quality measures and the use of evidence based protocols for physicians. During our annual request for proposal process with healthcare vendors, Verizon asks very deliberate questions about their involvement with BTE or other P4P efforts. BTE’s efforts to support the transformation of how care is delivered is a step in the right direction to help change and advance our healthcare system.