National Health Plan Implementations

The health plans Aetna, Anthem-Wellpoint, UnitedHealthCare, and CIGNA have included BTE Recognitions as a core component of how they measure physician quality.  As a result, physicians that contract with these plans anywhere in the country might be eligible for special incentives and recognitions.

AETNA:

1. Program Name: Aetna Aexcel Network
2. Program Type: Specialty network designation (not P4P)
3. BTE Endorsement: Yes
4. Physician eligibility: Specialists: Cardiology, Cardiovascular surgery, Neurology, Orthopedics, Gastroenterology, General surgery, Plastic surgery, OB/GYN, ENT, Urology, Vascular surgery.
5. Offered in select areas where there is plan sponsor commitment and robust Aetna network, among other criteria.
6. Evaluation includes a balance of clinical performance and efficiency measures. It is a group level assessment for practices that have a minimum number of Aetna episodes over the last 3 years.
7. Aetna Aexcel program uses recognition by NCQA or BTE in the clinical evaluation, and physicians that achieve recognition will meet the Aexcel clinical evaluation requirements.
8. Posts recognition status on member web site: Yes

Anthem-Wellpoint:

1. Program Name: Anthem-Quality-Insights
2. Program Type: Incentive based
3. BTE Endorsed: Yes
4. Physician eligibility: Select participating primary care physicians (MD’s or DO’s) who specialize in Family Practice/Medicine, General Practice/Medicine, Internal Medicine or Pediatrics as their designated primary specialty and are participating in commercial products.
5. The Anthem-Quality-Insights program is offered nationally, but in CO, GA, and NY the program incorporates and assigns significant credit for external recognition including BTE or NCQA recognition.
6. Evaluation is based on five components, 2 of which include a BTE or NCQA recognition as an option to fulfilling the criteria. It is a group level assessment for practices that have a minimum number of Anthem members.
7. Blue Precision:  Anthem’s Blue Precision program is a transparency    program based on quality and efficiency metrics. The BTE recognitions are also used as part of the quality criteria in the Blue Precision program.
8. Posts recognition status on member web site: Yes

UnitedHealthcare

1. Program Name: United Premium Designation  
2. Program Type: Network Designation 
3. BTE Endorsed: Yes, quality component only
4. Physician eligibility: To be eligible to participate in the Premium program, physicians must be contracted with UnitedHealthcare, practice in a specialty that is included in the Premium program and be board certified in their primary documented specialty.
5. United Premium Designation uses evidence-based and expert physician-derived consensus standards to evaluate physicians across 20 specialties using claims data for quality and cost efficiency.
6. A physician board certified in internal medicine and in a market where Premium is available would receive the Premium Quality designation if they are BTE-Recognized as an individual physician for Asthma, Cardiac, CAD, CHF, Diabetes, or Spine.
7. Posts recognition status on member web site: No

CIGNA:

1. Program Name: CIGNA Care Designation
2. Program Type: Network designation  (not pay-for-performance)
3. BTE Endorsed: No; but BTE Recognized
4. Population included: Commercial
5. Physician eligibility: Family practice and 21 specialty categories w/ 20 score able opportunities
6. Program description: CIGNA is available to their ASO clients to administer BTE on their behalf on a national or local scale. Currently CIGNA is administering BTE in several coalition-based implementations. CIGNA has begun the evaluation process to consider adding BTE Recognitions as part of the quality criteria in its CIGNA Care Designation program.