north carolina bte collaborative

August 7, 2009

North Carolina BTE Collaborative

George ChedraouiBTE Consultant

Bridges To Excellence, Proprietary & Confidential

NC Status

Date Paid Total Reward Amt

1Q08 $20,480

2Q08 $23,130

3Q08 $38,185

4Q08 $95,815

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

Region Eligible # Physicians

Potential # Patients Affected

Potential Rewards Amounts

Physician Recognitions

Charlotte 2,051 59,529 $2.9 million

396 physicians have 63% of the reward/savings

potential

POL -190

DCL – 298

CCL - 199

RTP 2,001 27,130 $1.4 million

136 physicians have 41% of the reward/savings

potential

POL - 76

DCL – 139

CCL - 42


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.


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


The additional technologies and BTE Care Links will increase the number of physicians assessed

Program/Pathway NCQA EMR Portal ABIM PIM

Diabetes

Cardiac

Hypertension

CAD

CHF

Asthma

COPD

Spine

POL/Systems Use

I. NCQA Provider Recognition Programs ($400)

II. BTE Automated Performance Assessment through MNCM & IPRO ($ Free)

Data aggregator (e.g. EMR, registry, decision support tool vendor) data submission

III. BTE-IPRO Direct Data Submission Portal

Physician upload of standardized file format ($95)

IV. American Board of Internal Medicine ($95))

Elect to supplement sample for Performance Improvement Module (PIM) data for submission through IPRO portal


We Used To Think These Forces Were The Main We Used To Think These Forces Were The Main Drivers of Costs. They Are, But……Drivers of Costs. They Are, But……

Waste due to information

deficiencies and defensive medicineMedical Technology

emerging at an accelerated rate

Costs of Uninsured drive overall

medical costs

Consumer Behavior

Lifestyle choices and cost sharing

Crisis in Primary care Access limitations,

failing office economics, flight to sub-specialty fields

Medical Errors affect the quality of care and increase costs; malpractice

Labor Shortage Provider & health plan

consolidation

Prescription drug costs

continue to grow significantly


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


Diabetes costs for a large employer

Typical

Care Defects

• Average total cost is ~ $6,000

• 89% of patients have some avoidable costs


North Carolina PACs

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

Potentially AvoidablceCosts

Typical Costs


North Carolina PACs

ConditionTypical NCCosts

Potentially

AvoidableNC Cost

Total NCEpisodeCost

Rate of NCPAC toTotal

CHF 7,259 25,931 33,189 78%

COPD 4,924 7,077 12,001 59%

Diabetes 5,970 5,540 11,509 48%

Hypertension 2,334 565 2,899 19%

CAD 8,654 3,349 12,003 28%

Adult Asthma 1,194 949 2,144 44%

Child Asthma 4,334 3,556 7,890 45%


North Carolina Opportunity for Savings

Yearly per patient savingsReducing PACs by

Best inCountryPAC rate

Potentialsavings perNC patient

6.00% 10.00% 15.00%

$1,556 $2,593 $3,890 CHF 35% $11,616

$425 $708 $1,062 COPD 33% $3,960

$332 $554 $831 DIA 21% $2,417

$34 $56 $85 HTN 12% $348

$201 $335 $502 CAD 11% $1,320

$57 $95 $142 ADLT 20% $429

$213 $356 $533 CHLD 25% $1,972


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.


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


To be successful in changing behaviors we have to continuously up the ante

Provider Risk & Reward

Em

ploy

er S

avin

gs


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?

north carolina bte collaborative

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