Reaping Rewards for By Bonnie Darves The trend toward standardizing treatment of certain diseases and chronic conditions and the push for more population-based care have met with mixed reviews among physicians. Many view the movement as a positive one that ultimately will result in better overall care and improved outcomes. Others are concerned that the operational and system modifications required in their practices can create additional financial burdens. A new pay-for-quality initiative called Bridges to Excellence is intended to address those concerns by enabling physicians who strive to improve performance to reap financial rewards. The program, developed by a coalition of physicians, health plans and large employers, rewards excellence in diabetes care, cardiovascular care and patient-care management systems. Physicians who participate in Bridges to Excellence and meet the performance criteria could see income gains of up to 10 percent in the form of bonus payments from participating employers. Patients who participate will also be rewarded through incentives provided by their employers. The first two initiatives, Diabetes Care Link and Physician Office Link, were launched in April 2003. The diabetes program was piloted in Cincinnati, Louisville and Boston, and the Physician Office Link program was tested in Boston. Humana has a unique position in the Diabetes Care Link initiative — it is participating as both a health plan and an employer in the Cincinnati and Louisville markets. Other participating employers include Ford Motor Co., Cincinnati Children’s Hospital Medical Center, General Electric Co., Procter & Gamble Co. and UPS. In addition to Humana, seven other health plans are involved in the initiative. The program operation and data compilation will be managed by an independent third party, the MEDSTAT Group. Under the program, physicians certified through the Diabetes Physician Recognition Program (DPRP), which is developed by the American Diabetes Association (ADA) and administered through the National Committee for Quality Assurance (NCQA), can receive up to $100 annually for each patient with diabetes who is employed by a participating company. To date, the program has been well received by Humana-network physicians in Louisville and Cincinnati, said Thomas James III, M.D., Humana’s chief medical officer for Kentucky. “The physicians have said that they appreciate the fact that there will be financial recognition for those who work harder to achieve DPRP certification,” he said. “Some see this as a way to make practice enhancements, such as hiring a patient educator.” The certification process, outlined on the Bridges to Excellence Web site at www.bridgestoexcellence.org, involves completing an application and providing diabetes- management data from 30 randomly selected patient charts. Physicians who meet the criteria in such areas as hemoglobin A1c (HbA1c) level testing as well as blood pressure, lipid profile and creatinine or bloodurea nitrogen (BUN) values, can obtain certification. The objective is to demonstrate with clinical outcomes that diabetic patients are well-managed and that their conditions are under control. Encouraging employees to take better control of their health is an important component of the project. Patients enrolled in the initiative will be provided with Web-based tools — including a personal Web site — to educate them about diabetes and assist them in tracking progress and treatment. They also will receive incentives for participating in programs devised by their employers. That should address one of the concerns physicians have about patients with diabetes: lack of compliance. “Many doctors have said, understandably, ‘I can only do so much. Patients need to have incentives, too,’” James said. David Bybee, M.D., a Louisville endocrinologist whose four-physician practice includes an estimated 5,000 patients with diabetes, and who has been involved through the Jefferson County Medical Society in gauging local physician response to the initiative, sees short- and long-term benefits. “The bottom line is that diabetes care that meets the ADA/NCQA standards results in healthier people and lower [medical] costs,” he said. For example, a study performed by the prestigious Marshfield Clinic found that a onepoint drop in HbA1c levels would bring a $400 annual per-patient reduction in direct medical care expenses — not to mention improved quality of life and work-productivity gains for the patients. Although some physicians have complained that standards — driven protocols are the equivalent of “cookbook medicine,” it’s important to note that the DPRP program and others like it are based on standards developed by leading physicians in their represented fields, both James and Bybee noted. “The point is that many physicians are trying
to provide good care, but if we can get more consistent high-quality
care, it’s really a win-win proposition,” said Ted Swirat, To date, about 2,800 primary care physicians and specialists in the pilot regions have been invited to participate in Diabetes Care Link. And although the program is limited to a few regions at present, the program’s expansion — the next component, Cardiac Care Link, is currently being developed — and its growing national recognition are likely to make it a model for future incentive initiatives. “Even though this is only a pilot, physicians throughout the country should keep an eye on what’s happening because this is likely to become more pervasive — it’s a model that’s likely to be expanded,” said James. For more information about participating in the Diabetes Care Link, visit www.bridgestoexcellence.org.
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