Bridges to Excellence
Perspectives on Program Implementation
Jon Conklin
Vice President, Medstat
BTE Program Administrator
Questions
• How is BTE Unique?
• What Challenges have been faced in Implementing BTE?
• What are the Key Success Factors?
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How is BTE Unique?
1. Program Design Based on the Business Case
• The BTE Business Case:
Incentives
$
Excellent
Health Care
Healthier
Patients
Preventive Screening
Fewer Complications
Disease Management
Fewer Medical Errors
Cost
Savings
Reduced Health Care
Costs
Increased Productivity
Clinical Information
Systems
• Elements of programs design relating to business case
– Outcomes measures
– Size of incentives/rewards
– Program focus
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How is BTE Unique?
2. Outcome Measurement is Critical
Why?
• ROI Research links Cost Savings to Improved Outcomes
• “Excellent Performance” =
1. Adherence to Clinical Guidelines (process of care)
2. Desirable Clinical Results (outcomes of care)
Implications?
• Outcome measures = lab results
blood pressure levels
• Chart abstraction required
• Physician self-report (with random audit)
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How is BTE Unique?
3. Rewards Must be Meaningful
• Size of incentives/rewards ~ 1/3 of anticipated cost savings
– e.g., Diabetes:
• Expected Annual Cost Savings = $300 - $350 per patient
• Reward = $100 per patient seen by “excellent” physician
• Rewards represent “new money”
• Lump-sum rewards – scaled based on patient volume
• Direct payment from employers (rather than through plans)
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How is BTE Unique?
4. Active Consumer Participation
• Encourage active consumerism
• Steer patients to “excellent” providers
• Reward self-care management
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Challenges of BTE Implementation:
1. Data Retrieval and Integration
Patients
Physicians
Health Plans
Medstat
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Challenges of BTE Implementation:
2. Physician Engagement
• Barriers:
– Initial skepticism & suspicion
– Perceived burden of data collection
– Application fees
• Strategies:
–
–
–
–
–
–
Solicit cooperation from physician organizations
Target physician communications
Aggressive outreach
Provide data collection assistance
Reward all qualifiers
BTE Newsletter
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Provider Outreach: BTE Newsletter
• BTE Newsletter includes:
− Program-related articles
− Lists of recognized physicians
and practices
− Best practices articles submitted
by recognized physicians
− NCQA performance
measurement information and
tips
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Challenges of BTE Implementation:
3. Consumer Engagement
• Barriers:
– Confidentiality
– Suspicion
– Apathy
• Strategies:
–
–
–
–
Broadcast communications
Recruitment by third-party
Incentives / Rewards for self-care and physician selection
Consumer education campaigns
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Consumer Outreach
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Challenges of BTE Implementation:
4. Estimating / Quantifying ROI
• Convince participants of ROI
• Develop BTE ROI Calculator
• Quantify actual ROI
– Quantify program impact
– Control for confounding factors
– Demonstrate cause and effect over time
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BTE Business Case: ROI Calculator
• Employer enters information
about employee population
and program assumptions
• Calculator determines
expected program costs and
savings
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Conclusion: Key Success Factors
• Critical mass re: employer participation (covered lives) in
specific markets
9 currently representing nearly 350,000 covered lives
• Active employer and health plan participation in each
market
9 13 large employers in 4 markets, 5+ new markets in 2005, United
Health Group first BTE managed care licensee.
• Buy-in by physician community
9 from 90 to over 800 new participating physicians in 2004
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