Bridges To Excellence

1. Bridges To Excellence www.bridgestoexcellence.org

2. Five Purchaser Principles Purchaser Keys Effectiveness and efficiency must improve dramatically for either the public or private sector to continue to provide healthcare coverage. We must transform the health care supply chain into a consumer driven market in order to see sustained cost and quality improvement. Patients must shift from passive health care recipients to engaged consumers Patients need transparent information about providers, decision-making tools and plan designs that link financial responsibility to decisions Health care efficiency and effectiveness can be improved using the same tools (IT & continuous process improvement) we use to improve quality and productivity in our businesses. Purchasers and consumers will reward providers demonstrating the greatest effectiveness and efficiency of care (instead of those with the unit price) as soon as they know which providers to reward. Data and measures are essential. Providers must be rewarded for investments that lead to better efficiency and effectiveness. Incentives must be aligned for purchasers, consumers, providers and health plans to come together . Purchaser Keys Effectiveness and efficiency must improve dramatically for either the public or private sector to continue to provide healthcare coverage. We must transform the health care supply chain into a consumer driven market in order to see sustained cost and quality improvement. Patients must shift from passive health care recipients to engaged consumers Patients need transparent information about providers, decision-making tools and plan designs that link financial responsibility to decisions Health care efficiency and effectiveness can be improved using the same tools (IT & continuous process improvement) we use to improve quality and productivity in our businesses. Purchasers and consumers will reward providers demonstrating the greatest effectiveness and efficiency of care (instead of those with the unit price) as soon as they know which providers to reward. Data and measures are essential. Providers must be rewarded for investments that lead to better efficiency and effectiveness. Incentives must be aligned for purchasers, consumers, providers and health plans to come together .

6. We created a multi-stakeholder group and designed the program to meet diverse needs Mission: Improve quality of care through rewards and incentives that (1) encourage providers to deliver optimal care, and (2) encourage patients to seek evidence-based care and self-manage their own conditions Focus: Reengineer office practices by adopting better systems of care Demonstrate the reengineering is working through better outcomes for patients with chronic conditions, starting with diabetes and cardio-vascular diseases

7. The process for recognition and rewards is straightforward

8. BTE uses standard nationally recognized measures of performance

9. Physician Office Link Savings

10. There are three programs based on the NCQA Physician Recognition Measures

11. We�ve Made Great Progress in Our Pilot Markets

13. Program Success Factors Critical mass re: employer and plan volume of covered lives in specific markets � currently representing nearly 350,000 covered lives Active employer and health plan participation in each market � currently 13 large employers in 4 markets, 5+ new markets in 2005; Health Plans now becoming licensed agents for BTE. Buy-in by physician community � from 90 to over 800 new participating physicians in 2004 Aggressive Communications strategy - Press releases to highlight physician success and key messages, Newsletter, Electronic distribution, community presense

14. Physician Office Link (POL) Measures Rewards Report Cards

15. POL: What is It? Specific process implementation reduces errors and increases quality Enables physician sites to qualify for bonuses Earn up to $50 annually per patient covered by participating employer or plan Report card created for each physician office Reports performance on program measures Report made available to public

16. POL: Program Description

17. BTE Incentives For PCPs

18. Physician Quality Ratings: Rating and Rank High-level roll-up of physician�s overall performance Distinguishes relative performance of physicians within each level Patients can express satisfaction or dissatisfaction about their primary physician

19. We�re going to continue building programs to cover most specialties

20. Our efforts have been incorporated in other national initiatives HRPA � 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 them CMS � we�re working with CMS on three of its demos: CMP, DOQ, DOQ-IT to make sure that our performance measures are synched up Health Plans � UHC has licensed BTE for their customers, along with CIGNA, CareFirst BCBS and NBCH

21. Participation in Bridges to Excellence Use the available BTE resources and experts Work with BTE Licensee to engage the market Lay of the land Key stakeholders Build the team Develop communications plan Build sense of urgency Sign BTE/Licensee/Health plan contracts Communicate to the market Create momentum Evaluate and tweak