What services are provided by the BTE
Administrator (formerly general contractor) in exchange
for the annual administrative fee?
The BTE Administrator is responsible for most day-to-day
BTE administrative matters, though they may divide some
of this work with the coalition. Depending on your contract,
an Administrator may provide one or more of the following
services:
Communication Services
(e.g., BTE 1-800 number, Provider mailings, Physician
contact database)Invoice & Reward Payment)
(e.g., Calculate and invoice for reward, Banking arrangement,
Send consolidated check to Physicians)
Reporting/Evaluation
(e.g., Consolidated monthly evaluation reports, Patient
and physician surveys)
Regional Management
(e.g., Conference calls/notes, Facilitation of market
decisions, Program promotion)
Market-wide Attribution & Processing
(e.g., Merge and link plan physician lists, create market
"Master Physician List" (MPL) of reward eligible
physicians, Create market-wide physician patient counts
across plans, automate file flows among stakeholders)
How do we ensure HIPAA compliance in
this model?
Data use and confidentiality agreements between employers,
contractors & health plans are HIPAA compliant.
As an employer, what
do I need to ask my health plan to do? Will the BTE Administrator
work with the health plan directly once I make the necessary
introductions & sign the appropriate agreements?
This varies by market. You may be asked to have your
health plan(s) provide requested data to the BTE Administrator
as defined by the region.
In addition, coalitions and the BTE Administrator will
work with the health plan(s) to develop physician recruitment
strategies (i.e., outreach to recognition) depending on
the agreement of that specific region.
Will the BTE Administrator communicate directly with
my employees?
There will be no communication between BTE Administrator
and employees in regards to POL, DCL and/or CCL.
What information can I expect to receive from BTE
Administrator once the program is live?
This will vary by market, but once the program is live,
examples of information that you may receive from the
BTE Administrator include: communication services and
program reporting.
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How are administrative fees & practice reward
payments allocated across employers in a region?
Administrative fees will depend on the specific market,
however each employer is billed by the BTE Administrator
according to the number of that employer's patients who
are seeing recognized BTE physicians in that specific
market.
How are administrative fees and practice reward payments
billed to my organization?
Billing will vary by market; however, the BTE Administrator
determines cost (based on contracted per patient rate)
and administers bills quarterly. The BTE Administrator
will invoice to accounts payable, collect payments &
issue consolidated reward checks to each practice.
How are administrative fees and practice reward payments
paid by my organization?
After collecting payments, the BTE Administrator will
send out a consolidated reward check to each recognized
practice.
How much rewards have been paid out (dollar max including
explanation of 20K per year and 50K lifetime)? For example,
have any physicians reached the maximum reward amount
in their markets?
As of August 2005, a total of $1.9M has been rewarded
to over 1,100 physicians. Caps are implemented because
BTE is a quality improvement initiative; the program is
not intended to become a 2nd source of income/salary for
physicians. No physicians to date have reached the maximum
reward amounts.
How does this all happen mechanically from an employer
perspective?
The majority of BTE related operations will be performed
through the BTE Administrator and business coalition,
as well as an employer/licensee staff member, or both.
The participating employer needs to do very little on
a day-to-day basis. However, employers can provide leadership
to bring other employers into BTE, to educate physicians
and employees about the program. Also, the employer should
communicate to its employees the benefits of seeking care
from physicians providing recognized quality care.
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What are the requirements for the data file between
the health plan and the BTE Administrator?
This varies by market, overall BTE Administrator will
be requesting data from the health plan by providing data
requirements and working with plans to develop data file;
employers activities include approving the Data Use Agreement.
How will I know how many of my employees have diabetes
and are part of the program?
If an employer is participating in a region that is implementing
the Diabetes Care Link (DCL) program, the invoice from
the BTE Administrator will indicate the number of diabetic
patients that are seeing BTE-recognized doctors.
What do I have to do as a participating employer?
What are the resource requirements?
Employers are expected to provide strategic leadership
by offering input, direction and feedback on strategy
& operational BTE issues. This typically requires
a project leader working in conjunction with a regional
steering committee consisting of employers, health plans
and other stakeholders.
How will I know which physicians in the area my employees
see?
You may have internal data systems that will provide
such information based on employment documentation completed
by your employees. Additionally, typically a BTE Administrator
collects data, attributes patients to physicians and provides
employers a "Master Physician List" or MPL listing
(unidentified) consisting of patient counts and quality
recognized physicians names.
Who is responsible for tracking program related information,
for example physicians who receive recognition, the number
of my employees seen by these physicians, which physicians
are eligible for rewards, the total amount of rewards
payments due, etc.?
This varies by market, however in a typical situation
the responsibilities of tracking program related information
lay with the BTE Administrator or business coalition.
How have employers benefited from this program in
other markets?
Initial data is still preliminary, but early data indicates
that certified physicians tend to be more efficient &
provide consistent treatment, with calculated savings
of approximately 10-15%Bridges to Excellence has performed
detailed program evaluations that are publicly available
for download. Please visit www.bridgestoexcellence.org.
Why should I agree to participate? What will my organization
get out of this?
By paying-for-performance in health care, BTE believes
employers will pay less overall healthcare costs for their
employees. Employers will further benefit since their
employees will be seen by nationally recognized physicians,
providing clinically guideline based standard care. Doctors
will receive incentives based on performance against key
measures of health care effectiveness. Providing care
for employees with chronic conditions is expensive. Employees
with poorly controlled diabetes miss an average of twelve
days of work per year due to the illness, compared to
just two days of lost time for diabetics whose illness
is well controlled. Savings will be realized by minimizing
complications, improving care, and avoiding lost work
and lowered productivity.
How are physicians notified about the program?
The BTE Administrator or coalition conducts initial targeted
and customized mailings with patient counts and potential
reward amounts when the program starts. Afterwards, physicians
are notified via continuous recruitment effort by local
market representatives (phone, office visits, meetings
etc).
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