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North Carolina BTE Collaborative

North Carolina BTE Collaborative. August 7, 2009. George Chedraoui BTE Consultant. NC Status . RTP increased from 19 to 258 recognized physicians since 2006. 13% of the eligible physicians are recognized. 396 physicians have 63% of the reward/savings potential

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North Carolina BTE Collaborative

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  1. North Carolina BTE Collaborative August 7, 2009 George Chedraoui BTE Consultant

  2. NC Status • RTP increased from 19 to 258 recognized physicians since 2006. 13% of the eligible physicians are recognized. • 396 physicians have 63% of the reward/savings potential • Charlotte increased from 91 to 687 recognized physicians since 2006. 34% of the eligible physicians are recognized. • 136 physicians have 41% of the reward/savings potential

  3. Health Plan Partnerships BCBSNC – Completed state-wide pilot of 3 BTE programs. Supporting BTE implementation for ASO customers. Working on integrating BTE and NCQA programs into overall physician performance assessment. Aetna – BTE baked in to Aexcel as a means to identify high performing specialists. Rewards paid on full book of business in select states. Supporting ASO customers in regional implementations CIGNA – Supporting BTE implementations in various regions for ASO customers. Working on network-wide incentive program using BTE programs as a part of how physician performance is assessed UHC – Supporting ASO customers in various regional implementations. Working on baking in BTE recognitions as part of overall physician performance assessment in Premium Network designation.

  4. Physicians increasingly have more options for BTE assessment through existing reporting initiatives

  5. The additional technologies and BTE Care Links will increase the number of physicians assessed • NCQA Provider Recognition Programs ($400) • BTE Automated Performance Assessment through MNCM & IPRO ($ Free) • Data aggregator (e.g. EMR, registry, decision support tool vendor) data submission • BTE-IPRO Direct Data Submission Portal • Physician upload of standardized file format ($95) • American Board of Internal Medicine ($95)) • Elect to supplement sample for Performance Improvement Module (PIM) data for submission through IPRO portal

  6. Crisis in Primary care Access limitations, failing office economics, flight to sub-specialty fields Medical Technology emerging at an accelerated rate Costs of Uninsured drive overall medical costs Waste due to information deficiencies and defensive medicine Medical Errors affect the quality of care and increase costs; malpractice Consumer Behavior Lifestyle choices and cost sharing Labor Shortage Provider & health plan consolidation Prescription drug costs continue to grow significantly We Used To Think These Forces Were The Main Drivers of Costs. They Are, But……

  7. Potentially Avoidable Complications (PAC) consume close to 50¢ out of every chronic care dollar Prometheus Payment, April 2009 The results of an analysis for a large employer in one state showed that $150MM, or roughly $1,700 per chronic care patient could be saved if PACs were reduced to zero

  8. Diabetes costs for a large employer Typical • Average total cost is ~ $6,000 • 89% of patients have some avoidable costs Care Defects

  9. North Carolina PACs

  10. North Carolina PACs

  11. North Carolina Opportunity for Savings

  12. Bridges to Excellence Achieves Value • Recognized physicians deliver better quality care: • Their submission and scoring of medical record data confirms this fact • Less variations in practice pattern • Recognized physicians deliver lower cost of care: • Patients seen by Diabetes Care Link physicians are 20% less likely to have an acute flare up (less defects). • The average savings for physicians recognized under the Physician Office Link is $363 per patient per year • The real transformation occurs when the programs are used together to drive systems use towards patient improvement.

  13. The key to positive ROI is to payout less than what you save These defects can be calculated for any condition by practice/group with more than 500 patients having that condition. For smaller practices, budgets per patient can be estimated prospectively as well as total bonus opportunities. Incentives get tied tightly to reductions in costs caused by care defects. The greater the decrease in these costs, the higher the bonus, and the greater the savings

  14. To be successful in changing behaviors we have to continuously up the ante Employer Savings Provider Risk & Reward

  15. Closing thoughts You can’t go up the glide path if you’re not on it – NC Collaborative and BTE have gotten us on and will keep us moving! The forces of the status quo have been greater than the forces of change….however that’s changing. If you don’t know how much money is currently being spent on avoidable complications (care defects), then how can you increase value in any significant way?

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