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Achieving PTE Blue Ribbons for 2009 and Beyond Why, When, and How!

Achieving PTE Blue Ribbons for 2009 and Beyond Why, When, and How! . PRISM January 22, 2009 Lisa M. Letourneau, MD, MPH Sue Butts-Dion, PTE Project Leader. Agenda. MHMC PTE transition to national metrics—brief overview Why national recognition

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Achieving PTE Blue Ribbons for 2009 and Beyond Why, When, and How!

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  1. Achieving PTE Blue Ribbons for 2009 and Beyond Why, When, and How! PRISM January 22, 2009 Lisa M. Letourneau, MD, MPH Sue Butts-Dion, PTE Project Leader

  2. Agenda • MHMC PTE transition to national metrics—brief overview • Why national recognition • Options for acquiring national recognition (how) • Timeline for the transition (when)

  3. MHMC PTE transition to national recognition • Align MHMC PTE with what is going on in the national environment—more up-to-date and raises the bar • Potential to achieve variety of levels of recognition • Levels 1, 2, and 3 • Increased opportunities for practices to achieve recognition—year round vs. annual • Reduce the potential for duplicative reporting • Speed up cycle time between reporting, improvement, reporting

  4. PTE 2009 & Beyond • April 2009: • PTE blue ribbons earned by previously submitting data to PTE change to green ribbons (“Maine recognition”) • Only way of gaining new blue ribbons is through NCQA or BTE (except pedi) • April 2010: • PTE green ribbons expire • Only way of gaining new blue ribbons is through NCQA or BTE (except pedi)

  5. Why national recognition • Earn blue ribbon designation with MHMC/PTE, thus making eligible for local employer’s tiered health benefits • Promotes a culture of progress and continuous improvement • Physicians can ID areas of practice that vary from performance criteria and take steps to improve

  6. Why national recognition • Demonstration to public and professional peers that you meet the standards of care as assessed by the programs and that you meet NQF/AQA quality measurement requirements • Favorably positions practice in the current national P4P environment

  7. Recognition Will Help Us by Promoting a Population-based Focus and a Systems Approach to Quality Improvement Infrastructure in place for continuous and consistent quality improvement Evolution of Readiness Apply for National Recognition Use a systems approach to care, to improve quality based on clinical outcomes for populations of patients Use of registries to care for individuals and populations of patients Focus on individual patients only

  8. Show me the…

  9. Primary Care Rewards 2009 and Beyond - Anthem • Anthem Quality Insights (AQI) Program • If recognized in NCQA’s or BTE’s clinical outcomes, AQI credit given for clinical outcomes, representing 10 points out of 100 • Note: AQI will not recognize PTE green ribbons for 2009 • If recognized by NCQA’s or BTE’s office systems surveys (PPC, PPC-PCMH,or POL), AQI credit given for 3 components of office system survey, representing 20 out of 100 points

  10. Primary Care Rewards 2009 and Beyond - Cigna • Proposing four criteria for recognition • NCQA PPC-PCMH levels 2 or 3 • Other NCQA physician recognition programs • BTE recognition • PTE 2-3 green ribbon practices • Highest performing practices will receive largest rewards

  11. Primary Care Rewards 2009 and Beyond – Aetna & Harvard • Aetna: has reserved funds for incentive payment using PTE green & blue ribbons • Harvard: will recognize PTE green & blue ribbons for incentive payments • Incentive payments are calculated on a per member per month basis • Providers are eligible to participate only through contracted local care units (LCUs) such as PHOs, IPAs, medical groups, and/or health systems) • Details of each to be determined

  12. MaineCare • Primary Care Physician Incentive Program (PC-PIP), for sites that provide care to adult members, have allocated a portion (10%) of the award based on the site’s performance on the Pathways to Excellence Blue Ribbon performance in office system survey, diabetes and cardiovascular disease outcomes. • A portion of the 10% of total dollars allocated for PTE performance is based on practices’ rank against peers for the total number of ribbons site received in the 2008 PTE, multiplied by the number of members assigned to the site.

  13. Employer Use 2009 and Beyond • State of Maine Employees • Will recognize PTE blue and green ribbons for their tiered network (lower PCP copays for “preferred providers”) • Bath Iron Works • Anticipate providing rewards for NCQA PPC-PCMH Level 3 • Hannaford • TBD

  14. How to Achieve National Recognition and Subsequent Blue Ribbons for Pathways to Excellence

  15. How to Achieve National Recognition and Blue Ribbons • Clinical Outcomes* • Diabetes • Cardiovascular • Office System Surveys • Basic • Medical Home * There are additional categories under development and Back Pain/Spine care Recognition programs exist but are not currently a PTE ribbon category.

  16. Clinical Outcomes-Diabetes & Cardiovascular • Diabetes • National Committee on Quality Assurance (NCQA) • Diabetes Physician Recognition Program (DPRP) • Bridges to Excellence (BTE) • Diabetes Care Link (DCL) • Cardiovascular • National Committee on Quality Assurance (NCQA) • Heart Stroke Recognition Program (HSRP) • Bridges to Excellence (BTE) • Cardiac Care Link (CCL)

  17. NCQA Diabetes Physician Recognition Program and Diabetes Care Link • Physician and physician groups voluntarily apply for Recognition by submitting information on their patients for the following standards: • Glycated Hemoglobin (HbA1c) Control • Blood Pressure Control • Lipid Control • Eye Examination • Smoking Status and Cessation Advice or Treatment • Nephropathy Assessment • Foot Examination

  18. NCQA Heart Stroke Physician Recognition and Cardiac Care Link • Physician and physician groups voluntarily apply for recognition by submitting information on their patients for the following measures: • Blood Pressure Control • Complete Lipid Profile • Cholesterol Control • Use of Aspirin or Another Antithrombotic • Smoking Status and Cessation Advice or Treatment.

  19. NCQA Diabetes Physician Recognition Program

  20. NCQA Heart Stroke Physician Recognition

  21. BTE Diabetes Care Link and Cardiac Care Link • BTE uses same clinical measures as NCQA • Three levels of recognition: • Level I: Set at about the 50th national percentile. “Classic” measurement of individual metrics summed to produce a score, threshold set to focus on above average performance • Level II: Set at about the 75th national percentile. Still focused on individual metrics, but all intermediate outcome measures are “must pass”. Composite measures. • Level III: Set at about the 90th national percentile. Physicians must demonstrate that they are using advanced processes and delivering all the right care to patients. Composite measures.

  22. Office System Survey • Office System Survey • National Committee on Quality Assurance (NCQA) • Physician Practice Connections (PPC) • PPC Patient-Centered Medical Home (PCP-PCMH) • Bridges to Excellence (BTE) • Physician Office Link (POL) • BTE Medical Home

  23. NCQA Physician Practice Connection (PPC) Office Systems Survey—PTE Physician Practice Connection-NCQA

  24. NCQA PPC-Patient Centered Medical Home (PPC-PCMH) • Separate certification from NCQA PPC, intended to reflect principles of Patient Centered Medical Home model • Has 9 “Standards” that include 10 potential “Must Pass” elements • Can achieve 3 levels of recognition

  25. NCQA PPC-PCMH Scoring

  26. BTE Physician Office Link (POL) • Focuses on utilization of EHR and care management processes (PTE was more specific with the questions for intervention plans and patient self management) • Includes section on patient access—demonstration of processes that support patient access • Requests proportions of time practices use their EHR for specific tasks (PTE asked EHR used for specified task for most of their patients--yes/no) • Routine on-site assessment process

  27. Pediatrics • Clinical: Able to submit asthma and immunization data via the MHMC • Contact Sue Butts-Dion for additional information 207-283-1560 or sbutts@maine.rr.com • Office systems: Will need to seek national recognition for office system survey

  28. Cost * Fees are quoted based on one physician applying with BTE discount. Please refer to www.ncqa.org and www.bridgestoexcellence.org to review fee schedules for multiple physicians or physician groups.

  29. Stories from the field.. • Time • Degree of difficulty • Tips for success • Maggie Welling • Lori Newcomb

  30. Which Option Is for You? Some Considerations BTE NCQA

  31. Timeline for the Transition • Current blue ribbons will transition to green or blue ribbons on April 1, 2009 and stay up through March 31, 2010 • Those with national recognition designation as of April 1st, 2009 will retain blue ribbon • Those with current blue ribbons not based on national recognition will transition to Maine “green” ribbons • Those that apply for national recognition and do not meet NCQA/BTE standards by April 1st, 2009 will be awarded Maine green ribbon if scores are > 60 points • Pediatricians will have annual opportunity to submit asthma and immunization data to PTE until national program is developed

  32. Blue Ribbon • National • 3 levels • BTE/NCQA • Green Ribbon • Maine • 1 Level • BTE 60-74 • BTE <25 pts • ? Claims For Illustration Only

  33. Suggested Next Steps • Review your aim and capabilities in relation to some of the considerations discussed today. • Financial resources • Human resources • Weigh options in relationship to your current environment. • Make a list of your unanswered questions and pursue answers.

  34. Resources • www.ncqa.org • (202) 955-3500 or 1-888-275-7585 • www.bridgestoexcellence.org • www.mhmc.info • Sue Butts-Dion 207-283-1560 • Ted Rooney (207) 729-4929 • www.MEHMC.org • Local PHOs, provider groups

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