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Pay for Performance Trends - Bridges to Excellence in Minnesota. MNACHC Annual Conference October 13, 2006. Who is the Buyers Health Care Action Group?.

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Pay for performance trends bridges to excellence in minnesota

Pay for Performance Trends - Bridges to Excellence in Minnesota

MNACHC Annual Conference

October 13, 2006

Who is the buyers health care action group

Who is the Buyers Health Care Action Group?

The Buyers Health Care Action Group is a coalition of public and private employers working torecreate the health care systemso consumers will get the care they needin theright place, at theright timeand attheright price. We develop purchaser strategies and seek out consumer information tools that promote asafe, timely, efficient, effective, equitable and patient-centered health care system.

Bhcag members

Allina Hospitals

Alliant Techsystems


Barry Wehmiller

Berlex Labs


Carlson Companies


Minnesota Life


Olmsted County

Park Nicollet

Resource Training and Solutions




Target Corporation

St. Jude


TCF Financial

University of Minnesota

US Bank



General Mills





Land O’ Lakes

Merck & Co.

Wells Fargo

BHCAG Members

Fifteen years of market driven reform

Fifteen years of market driven reform

  • First RFP established long term relationship with Health Partners - “Choice Plus” benefit program is created

  • The Institute for Clinical Standards Integration is formed in response to the request for treatment guidelines and clinical quality improvement

  • The Minnesota Health Data Institute is created to gather and publish health care information for consumers

  • The Robert Wood Johnson Foundation provides five year funding for the Minnesota Health Partnership on Integrated Disability Management

Fifteen years of market driven reform1

Fifteen years of market driven reform

  • The Department of Employee Relations joins BHCAG, demonstrating the value of public/private relationships

  • Nationally recognized Direct Contracting Model featuring defined contribution, risk adjusted payment methodology and “tiered networks” is introduced

  • BHCAG publishes consumer report cards

  • BHCAG creates the Excellence in Quality Awards to provide cash and recognition to providers demonstrating superior quality improvement

  • BHCAG spins off new for profit health plan, Patient Choice Healthcare, Inc.

Fifteen years of market driven reform2

Fifteen years of market driven reform

  • BHCAG provides seed grant to new non-profit organization, HealthFront, comprised of providers, employers and consumers

  • BHCAG creates a National Data Cooperative providing members the tools and analytic support needed to support strategy development and decision making

  • BHCAG, a founding “frog”, becomes a regional lead in the implementation of the Leapfrog Group patient safety criteria

  • With BHCAG support and direction, the Minnesota Hospital Association achieves 100% participation - in both urban and rural hospitals - posting information to the Leapfrog website

Fifteen years of market driven reform3

Fifteen years of market driven reform

  • Advocated for the creation of the Adverse Events Reporting Act; provided financial assistance for implementation

  • Founded the Broad Alliance of Minnesota Purchasers; later embraced by the Governor as the “Smart Buy Alliance”

  • Assist in development of statewide HIT policy and direction through participation on HIT Advisory Committee and Board of Directors for Minnesota Health Care Connection

  • Created the BTE Guiding Coalition and led the implementation of Diabetes Care Link P4P program statewide (226,000 covered lives and counting!)

  • Gained broad acceptance of eValue8 as an evaluation, reporting and market reform tool, in both the private and public sector

Value based purchasing pay for performance rewarding results

Value Based Purchasing - Pay for Performance - Rewarding Results

  • The Quality Chasm recommendation - align incentives and create rational payment systems

  • Value Based Purchasing = Measure, Report, Reward

  • P4P Gaining momentum:

    • more than 84 payer programs nationally in November 2004

    • 125+ payer programs in November 2005

    • CMS (Federal Medicare and Medicaid Agency) Programs

      • Premier Hospital Quality Incentive Program

      • Physician Group Practice Demonstration

      • Chronic Care Improvement Program

      • others

Bridges to excellence bte the national program

Bridges to Excellence (BTE) –The National Program

  • Started by GE, Verizon, Ford, UPS and other large employers to accelerate quality improvements in local markets by leveraging their collective purchasing strength

  • Rewards physicians for

    • Diabetes care

    • Cardio-vascular disease care (CVD)

    • Physician office link (POL); coordinating care, results reporting,

      e-prescribing, performance reporting, use of information technology

  • Overall focus is on re-engineering physician office practices to increase quality and improve efficiency

  • Individual physicians are accredited by NCQA (National Council of Quality Accreditation)

  • Gaining momentum

    • 100+ employers participate in BTE nationally

Three programs or modules

NCQA Measure set

Physician Activation

Consumer Activation

  • Physician Office Link (POL)

  • Physician Practice Connections (PPC)

  • Up to $50 pmpy

  • Physician-level report card, and patient experience of care survey

  • Diabetes Care Link (DCL)

  • Diabetes Provider Recognition Program

  • Up to $100 pdppy

  • Diabetes care management tool, and rewards for care compliance

  • Cardiac Care Link (CCL)

  • Heart Stroke Recognition Program (HSRP)

  • Up to $160 pcppy

  • Cardiac care management tool, and rewards for care compliance

Three Programs or “Modules”

Why minnesota

Why Minnesota?

  • Employer leadership and collaboration

  • History of successful provider collaboration

  • Demonstrated health plan collaboration and innovation

  • Minnesota defined as Stage IV in application of the Market Model for patient safety. Readily transferable to other quality improvement efforts

    • Acknowledgement

    • Differentiation

    • Innovation

    • Reward

Minnesota building blocks

Providers and health plans develop consensus on evidence based guidelines, relevant measures, and provide implementation support

Aggregate payer data, review physician performance according to ICSI measures, publicly report results

Reward performance through existing health plan programs and BTE

Minnesota Building Blocks

Building on existing minnesota best practices

Building on Existing Minnesota Best Practices

  • Institute for Clinical System Improvement (ICSI) developed measures and obtained physician consensus on levels of performance (MN measures are higher than NCQA measures)

    • Must meet all four (for CVD) or five (for diabetes); not just one

    • Measures on outcomes, not process

    • More aggressive outcomes, e.g., HgbA1c of <7 not <8

  • Minnesota Community Measurement (MCMN) - data aggregation, quality review, public reporting for increased transparency

    • Using MNCM reduces administrative costs by 66% over BTE costs in other markets

  • Consensus reached on consistent measures to be used by all payers for rewards

Why diabetes for minnesota bte

Why Diabetes for Minnesota BTE?

  • Common direction - community-wide return

  • Builds momentum and greater rationale for physician re-engineering efforts

  • Minnesota is a P4P state but programs are not aligned

  • It’s needed - the current “best” is poor

    • 12 % of patients meet Optimum Diabetes Care (all 5 “easier” criteria) today

    • Goal of 30% in 2007

    • QCare goal - 80% by 2010

  • Provide influence on strategy and future programs

The mn bte guiding coalition



Blue Cross Blue Shield

Carlson Companies

Community Measurement

Fairview Medical Group

Health Partners

Institute for Clinical System Improvement (ICSI)


Minnesota Medical Association


State of Minnesota Department of Employee Relations

State of Minnesota Department of Human Services

The MN BTE Guiding Coalition

MN BTE is governed by representatives from key community stakeholders to

ensure collaboration, consensus and the success of the program.

The mn bte champions of change

The MN BTE Champions of Change

  • 3M

  • Carlson Companies

  • General Electric

  • Honeywell

  • Medtronic

  • State of Minnesota Department of Employee Relations

  • State of Minnesota Department of Human Services*

  • Visiant (formerly Josten’s)*

  • Wells Fargo

    * New champions for 2007

The Champions of Change are early adopters of MN BTE. These

entities are taking the lead in publicly signaling the medical

community that health care purchasers want to pay and reward providers

for optimal care, not quantity of services performed.

In 2006 minnesota bte will pay for

In 2006, Minnesota BTE will pay for...

  • Optimal diabetes care - 5 measures must be met by each patient

    • HbgA1c < 7

    • LDL < 100

    • BP < 130/80

    • Non-smoking status

    • 40 y.o. + daily aspirin use

  • Performance threshold

    • Goal of 10% of diabetic patients

      (9 out of 53 medical groups)

Why diabetes and cardiovascular disease

Why Diabetes and Cardiovascular Disease

  • Diabetes and CVD are two of the most prevalent and fastest growing chronic illnesses in the United States.

    • In 2002, diabetes cost $132 billion in medical expenditures and lost productivity*

      • 11% of U.S. health care expenditures

      • Affects estimated 15.7 million people (30% are undiagnosed)

      • 62.6 million visits to doctors

    • Estimated cost of some form of heart disease in 2006 is $403 billion (up from $298B in 2001)**

      • Affects 1 in 5 Americans (60.8 million people)

  • Quality of care received varies considerably from physician to physician.

  • Diseases have a tendency to be co-morbid; an estimated xx of people with CVD also have diabetes.

  • Proven return on investment when patients receive optimal care for these diseases.

    * American Diabetes Association

    ** American Heart Association

In 2007 measures of optimal care



Hgb A1c






One aspirin daily

45+ years





Blood Pressure



130/80 if diabetic

In 2007, Measures of Optimal Care

Mn bte the advantages

MN BTE – the Advantages

  • Program developed in late 2004 and 2005, with first rewards paid in 2006 to nine medical groups for Optimal Diabetes Care; Cardiovascular Disease added in mid 2006

  • Builds on existing, locally accepted measures, processes, methodology - accelerating provider buy-in

  • Higher performance targets and incentives for improvement every year (national program is every 3 years)

  • Utilizes established infrastructure to minimize administrative costs (MN Community Measurement)

  • Additional transparency on performance for all medical groups (national program is only for providers who apply to be accredited)

  • Incorporates national BTE principles and approach to pay for performance, but is modified for our unique market structure

  • Approved by BTE and viewed as a pilot model for other markets

Minnesota bte long term goals

Minnesota BTE Long Term Goals

  • Include small employers without burdensome administrative fee

  • Include public sector clients

  • Include small physician practices by promoting adoption of technology and services that support re-engineering

  • Reward group practices while assuring individual physicians within groups are measured and rewarded

Think nationally act locally

Think Nationally; Act Locally

  • National health care problems can turn into action by considering local health care market, resources, economics, and culture

  • Build on existing initiatives and local strengths

  • National quality standards (or higher)

  • Local reporting (for now)

  • Payment from local and national payers

For more information

For more information

Carolyn Pare


Buyers Health Care Action Group

7900 International Drive Suite 1080

Bloomington, Minnesota 55425

952 896 5185

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