BTE
Coalition FAQs
Do I need to
hire an additional staff person to coordinate BTE activities
for my organization?
This will vary
by each market but in a typical situation there is a project
leader who is in charge of activities such as overseeing,
managing, coordinating and providing operational leadership.
In some cases, a coalition may also take one some day-to-day
BTE management responsibilities, which could create a need
for additional staff resources. Coalitions interested in implementing
BTE are encouraged to contact BTE staff and NBCH to discuss
their particular circumstances.
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)
HIPAA
How
do we ensure HIPAA compliance in this model?
Data use and confidentiality
agreements between employers, contractors & health plans
are HIPAA compliant.
BTE
Administrator Communications
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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Fees &
Rewards
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.
Requirements
& Recognition
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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