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BTE program information is available


Aetna offers BTE program in Austin


Aetna-participating physicians in Aus- tin may be eligible for financial bonuses through one of the health plan’s quality incentive programs offered in conjunc- tion with Bridges to Excellence (BTE). BTE, a national pay-for-performance


program of the Health Care Incentives Improvement Institute, recognizes and financially rewards participating physi- cians for meeting certain evidence-based, clinical performance standards for care quality. BTE offers physicians recogni- tion in more than a dozen different pro- grams, including diabetes, cardiac care, hypertension, depression, and spine care. Most of the programs focus on chronic conditions. In July, Aetna began offering the BTE Diabetes Care Recognition Program for members of the Teacher Retirement Sys- tem (TRS) of Texas. It will be in effect for two years. Through the program, eligible phy- sicians can earn $100 annually per eli- gible diabetic patient (nongestational diabetic patients aged 5 and older cov- ered by the TRS health plan). That plan also includes Medicare-eligible patients and their dependents covered either by Medicare or a commercial plan. Reward maximums are $20,000 per


physician, per year, and $50,000 while the program is in effect. The incentive payments are in addition to any regular Aetna payments doctors receive. To qualify for BTE payments, a physi- cian must be the primary care physician for the diabetic TRS patient and demon- strate that he or she provides diabetes care that meets established guidelines. BTE standards for diabetes include mea- sures of hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol control.


Additional measures track whether


patients are getting routine ophthalmol- ogy, nephropathy, and podiatry examina- tions, and assess smoking and tobacco use and cessation.


30 TEXAS MEDICINE December 2012


at www.bridgestoexcellence.com. There, doctors also can look up their eligible patient counts across all BTE-participat- ing health plans. Doctors also must achieve recognition by the National Committee for Quality Assurance’s Diabetes Recognition Pro- gram (DRP) or another BTE-accepted organization at some point while the Aetna program is in effect. For information on DRP certification, physicians may visit www.ncqa.org/drg, call the National Committee for Quality Assurance at (888) 275-7585, or email drp@ncqa.org.


Aetna also encourages physicians to contact their local representatives or medical directors for help.


The first annual incentive payments


are expected to hit the mail in the third quarter of 2013. To be eligible for this re- ward, physicians’ DRP recognition must be in effect by June 2013.


ing Committee looked at measurement gaps in care coordination, with a partic- ular focus on the role of health informa- tion technology. The forum looked at 15 coordination


measures in all. The final 12 that re- ceived endorsement ask physicians, hos- pitals, and others to evaluate things like:


• Acute care hospitalization, • Emergency department use without hospitalization,


• Advance care plans, • Medical home surveys, • Timely initiation of care, • Care for older adults, • Medication reconciliation postdis- charge, and


• Timely transmission of transition records.


At a time when comprehensive qual- ity measures for care coordination are lacking, the steering committee Cochair Donald Casey, Jr., MD, says he hopes the measures will fill that void and set the stage for future efforts. “Ultimately, we want to see measure


NQF endorses care coordination measures


Calling care coordination “an essential ingredient” in improving health care quality and patient safety, the National Quality Forum (NQF) has endorsed 12 measures that help assess such efforts and give physicians, hospitals, and oth- ers in the medical community tools to collaborate on providing more efficient and effective care. The measures run the gamut from


reconciling patients’ medications when they are discharged from hospitals to es- tablishing advance care plans and mak- ing medical records available to patients in a timely manner.


The Institute of Medicine estimates


that care coordination initiatives that ad- dress complications such as communica- tion and medication errors, preventable hospital readmissions, and emergency department visits could save as much as $240 billion in health care spending. The NQF’s Care Coordination Steer-


Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at amy.sorrel@texmed.org.


developers align their efforts with NQF’s Preferred Practices for Care Coordina- tion,” he said. Dr. Casey added that there are a wide range of applications for these coordi- nation measures, including the patient- centered medical home; developing and implementing proactive and patient- centered care plans; effective commu- nication between patients, families, and caregivers; efficient information systems that support timely communication; and transitions of care that promote safe, ev- idence-based practices. Such measures will become increas- ingly important as the number of older patients with multiple chronic condi- tions continues to grow and their treat- ment requires more complex care, NQF leaders noted. n


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