Bridges To Excellence

1
Citizens Health Care Working Group
Boston, Massachusetts August 17, 2005 Jeffrey
R. Hanson, MPH Regional Health Care Manager, Veri
zon Communications President, Bridges to Excellen
ce Board Member, Leapfrog Group
2
We created a multi-stakeholder group and designed
the program to meet diverse needs

• Mission
• Improve care quality 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

3
Were a not-for-profit company with a Board and a
Leadership Council
Board

• BTE Participants Licensees
• Dale Whitney 2 years
• Jeff Hanson 3 years
• Francois de Brantes 3 years
• Vince Kerr 2 years
• Renee Turner Bailey (through 12-31-2005)Martin
  Sepulveda (as of 01-01-2006) 2 years
  
• Other Stakeholders
• Suzanne Delbanco 3 years
• Tom Lee 3 years
• George Isham 2 years
• Andy Webber 2 years

BTE Executive Committee Jeff Hanson, President
Dale Whitney, Secretary Francois de Brantes, Trea
surer
4
We have three programs that are operational now
5
Were building programs to cover most specialties
2007
2006
2005
PPC version 2.0
All Docs
Patient Experience of Care
PCPs (IM, FP, Gyn, Ped, etc.)
PCP Recognition Program
Endo
DPRP
Cardio Neuro
HSRP
Ortho Rheum
MSK RP
Oncologists
Cancer RP
6
Weve made great progress in all our pilot
markets already
7
Were continuing a rigorous evaluation, but weve
learned a lot

• What we know
• DPRP docs are more efficient, by 10 - 15 when
  looking at diabetes costs alone, by 5 when
  looking at overall costs
  
• The average gross savings per patient is about
  250 per year
  
• POL docs are more efficient, by 5 to 10 when
  looking at total costs of care
  
• The average gross savings per patient is about
• What we dont know
• Are DPRP POL docs more efficient over time?
  Were also getting the answer from two sources
  
• Ingenix Mercer

8
DPRP recognized physicians are more efficient and
have lower variation in costs
9
POL Recognized PCPs as a group are more
efficient, especially Ob-Gyns
10
The Louisville market has yielded many lessons
that can help you

• At launch 4 recognized physicians, today 36
• The Challenge
• Physician Philosophy driven regionally
• Outside of Norton Healthcare, physicians are not
  organized into large practices/systems, limited
  resources
  
• Single product market 63k lives 3500
  diabetics
  
• The Lessons Need both a push and pull approach
• Basic outreach follow up increased patient
  from 4 to 13
  
• Extraction services supported by grants has
  increased pipeline to 20-30 physicians for DPRP
  
• Public support from multiple sources all
  pushing for the same thing
  
• Physicians are learning what constitutes
  guideline care and receiving the tools to support
  it in lieu of EMR to get them there
  
• Patients need to get in the game through
  incentives

11
Lessons Learned in each market will help us in
all future markets

• Louisville small independent practices need a
  lot of hand holding to get them over the
  humpeven when they have a lot of rewards at
  stake.
• Cincinnati using third party chart extractors
  is a powerful way to reduce barriers to
  reporting. Grant funding is available for that
  process.
• Boston engaging large groups and training the
  trainer is critical to getting rapid program
  uptake.
  
• Albany most IPAs, even smaller ones, are eager
  to adopt standard processes and welcome the
  business case that this program brings them to
  convince their members to make the needed
  investments.

12
Consumers are engaged through our report card web
site

• High-level roll-up of physicians overall
  performance
  
• Distinguishes relative performance of physicians
  within each level

Bridges To Excellence, Proprietary Confidential
13
Effectiveness results come from NCQA, patient
experience of care from employees
Bridges To Excellence, Proprietary Confidential
14
Consumers are also engaged through WebMD

• Four-step process
• Create a profile to establish baseline
• Use CareGuide with doctor to set long term goals
• Use CareJournal to track progress
• Earn CareRewards by answering the self-care
  questions

Bridges To Excellence, Proprietary Confidential
15
We now have three plan licensees and a strong
alliance with NBCH

• Health Plans
• UHG United Health Group has up to ten markets
  it is focused on, including Omaha, South Florida,
  Central Florida, St. Louis, Dayton
  
• CareFirst BCBS will be rolling out POL on a
  limited basis
  
• CIGNA has committed to implementing BTE in AZ,
  NC and parts of TX
  
• NBCH There are currently four coalition markets
  ready to start one or more BTE programs
  
• Heartland Healthcare (IL)
• Tri-State Health Care (IL/MO/IA)
• Employers Health Coalition (AR)
• Colorado Business Group on Health

16
Additional Interest In Over 30 Markets
17
Our efforts have been incorporated in other
national initiatives

• CMS were working with CMS on three of its
  programs CMP, DOQ, DOQ-IT to make sure that our
  performance measures are synched
  
• BTE and CMS will be jointly implementing
  incentives in MA and Arkansas (through a local
  NBCH coalition), and possibly Utah
  
• Human Resources Policy Association (HRPA) and
  Care Focused Purchasing (CFP)
  
• HRPA has two initiatives National Affordable
  Regional that are tied to BTE ( Leapfrog) by
  linking up with plans that use/promote BTE
  programs.
• CFP has also agreed to use BTE Program measures
  in how they evaluate high-performing physicians

18
Contacts and Additional Information

• Additional program information
  www.bridgestoexcellence.org
  
• Specific questions on regional roll out and BTE
  programs bridgestoexcellence_at_thomson.com