Bridging the quality chasm

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Bridging the quality chasm

Blue Cross and Blue Shield of Texas and Bridges to Excellence collaborate to recognize and reward Texas physicians

By Eduardo Sanchez, M.D.
Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Texas

Here’s a riddle many physicians have reflected on with some frequency: How do you increase the quality of patient care, enhance practice income, and, at the same time, reduce the cost of health care? For Texas physicians, Blue Cross and Blue Shield of Texas and Bridges to Excellence are beginning to crack that conundrum.

How? BTE makes it their mission to help clinicians build their practices, help patients get healthier, and help insurers and employers manage costs better. In fact, BTE programs recognize and reward clinicians who deliver superior patient care and place a special emphasis on managing patients with chronic conditions, who are most at risk of incurring potentially avoidable complications.

That’s why Blue Cross is a sponsor of the BTE organization and specifically supports their Diabetes Care Recognition and Cardiac Care Recognition programs. The sponsorship is a result of BCBSTX’s commitment to making health and wellness a priority for its members, and BCBSTX financially rewards physicians for their performance and their BTE recognition status in the diabetes and cardiac care programs.

The goals of BCBSTX sponsorship of BTE are to:

  • Improve patient outcomes and quality of life.
  • Financially reward physicians who provide superior care to members with diabetes and cardiac disease.
  • Reduce the economic burden of caring for BCBSTX members.
  • Link into other established Blue Care Connection medical and dental programs that interact directly with members to help improve their health and disease condition.

We understand the value of BTE-recognized physicians in treating members with chronic conditions. In response, BCBSTX has developed a statewide program that provides financial incentives to physicians who seek and obtain BTE recognition and who treat members with diabetes and cardiac disease. BCBSTX offers BTE-recognized physicians the opportunity to earn $100 per selected patient, per year, per program for providing excellent care.

The BCBSTX-BTE collaboration also has received high marks from the physicians who participate. “This is a significant shift for providers,” says Scott Conard, M.D., chief medical and strategy officer at Medical Edge Healthcare in Dallas. “Ensuring a patient gets appropriate, timely, comprehensive care requires the development of new systems of care. This takes capital. Before this program, it was a labor of love. This is the beginning of systematically paying for quality, which will drive higher and higher quality while reducing waste and redundancy. As the old adage says, ‘you get what you pay for,’ and finally the financial and quality will unquestionably and clearly be aligned.”

Blue Cross and Blue Shield of Texas believes that the collaboration is a win-win for patients and primary care practices. We want to see more of our members and more of our providers, physicians, and non-physicians reaping the benefits of this program, which reinforces and financially rewards high-quality primary care and that also results in better outcomes and lower costs.

To achieve these goals and outcomes, BTE programs are designed around three key lessons gained from research and experience.

First, it’s critical to measure what matters most—the handful of indicators that have truly significant clinical and financial impact. These are the quality measures most predictive of improved patient health. These measures also form a set of indicators to help practices identify patients who are not well controlled and need more proactive management.

Second, clinicians who follow those quality measures will consistently provide better care at lower costs. Typically, they outperform their peers on process measures of quality and have lower average costs per patient and per episode. In part, this is because they tend to rely more on evaluation and management and less on tests and procedures; they know costlier care is not always better care.

Third, incentives only work if they are fair, so clinicians who continually improve their practices are rewarded appropriately. As physicians improve the management and treatment of chronic conditions, more patients should be encouraged to utilize them. As in any industry, the best performers should earn the most and have the biggest market share.

Several studies have shown how BTE recognition leads to improved physician performance, better patient health, and reduced costs of care. Patients of BTE-recognized physicians with chronic conditions generally had fewer hospital admissions and were healthier, on average. In addition, recognized practices reported a higher level of shared accountability between patients and providers. As a result, these patients typically are better managed and incur fewer hospitalizations and emergency department visits.

After BTE recognizes a physician in either its Diabetes Care Recognition program or the Cardiac Care Recognition program, BCBSTX will identify members with diabetes or cardiac disease for their respective physicians. Recognized physicians will be asked to provide biometric information and will then be eligible for the financial reward. There is no cap on the number of patients per year for which a physician may receive a financial incentive.

To date, the number of BTE-recognized physicians in Texas has gone from less than 40, when the BCBSTX recognition program was initiated, to almost 400. That growth has been realized in 18 months. BCBSTX wants to double the number of BTE-recognized physicians in 2011.

In fact, BCBSTX encourages all physicians in Texas treating patients with diabetes or cardiac disease to seek and obtain BTE recognition. Once recognition is achieved, all physicians are automatically eligible for participation in the BCBSTX BTE program. For more information, please visit the BCBSTX BTE website at