Bridges to Excellence (BTE) has five new programs in place to assess diagnosis improvements, and the treatment and management of chronic conditions such as asthma, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease and hypertension.
The BTE programs provide incentives to reward physicians and practices so that they are able to adopt better systems of care. The Programs results in physician practice reengineering, the adoption of health IT, and good outcomes for patients. Doctors that demonstrate excellent performance can earn recognition and also qualify for incentives from participating employers and health plans.
The new programs to earn incentives include:
• Asthma Care Link—Physicians must meet benchmarks on lung function testing and monitoring, appropriate asthma medication therapy, smoking cessation, and provide for annual flu vaccinations
• Congestive Heart Failure Care Link—Physicians must meet benchmarks on measuring LV function assessment, appropriate ACE-I/ARB therapy, and on assessing patient activity levels
• COPD Care Link—Physicians must meet benchmarks on measures such as spirometry evaluation and monitoring, appropriate use of inhaled bronchodilators, smoking cessation, and provide for annual flu vaccinations
• Coronary Artery Disease Care Link—Physicians must meet benchmarks on measuring blood pressure and lipid management, aspirin/anti-thrombotic use, and beta blocker use following an MI
• Hypertension Care Link—Physicians must meet the benchmarks on measuring blood pressure and lipid management, aspirin/anti-thrombotic use, diabetes screening, and counseling for diet and physical activity
Blue Cross and Blue Shield of Texas (BCBSTX) are now licensed as a sponsor of a new BTE program that will improve quality management of patients with chronic diseases. Because of the growing prevalence of diabetes in Texas, BTE and BCBSTX will reward physicians who deliver consistent effective care for diabetic patients.
In addition to the BTE diabetes program, BCBSTX is focused on metabolic syndrome. Metabolic syndrome is the presence of a cluster of any three of the five conditions found in one patient such as an unhealthy waist circumference, having diabetes or being pre-diabetes, high blood pressure, high triglycerides, or low HDL. Plans are to raise awareness and engage individuals at risk to eat healthier and be more physically active.
BTE is the operational partner of PROMETHEUS Payment Inc which is in place to provide both administrative and programmatic support. The idea is to provide a new provider payment model that offers a different approach to payment to include all of the providers treating a patient for specified conditions.
This new approach based on Evidence-Informed Case Rates (ECRs), calls for care coordination, and a consumer driven environment. Pilots are ongoing and the program is currently being tested in Illinois, Minnesota, and Pennsylvania. Refinements and adjustments to the model will be made based on the pilot site test results.
For more information on the programs, go to http://www.bridgestoexcellence.org/.
