Bridges to Excellence Pilot

Blue Cross and Blue Shield of North Carolina

Blue Cross and Blue Shield of North Carolina (BCBSNC) launched its three-year Bridges to Excellence (BTE) pilot program in April 2006. The pilot recognized and financially rewarded selected physicians who attained quality standards set by the National Committee for Quality Assurance (NCQA). All three of the NCQA physician recognition programs were included in the pilot: Physician Practice Connection (PPC), The Diabetes Physician Recognition Program (DPRP) and the Heart/Stroke Recognition Program (HSRP). The physicians in the pilot were given extensive support and guidance by BCBSNC as they proceeded through the NCQA recognition process. Methods of support included help from quality management consultants, monthly meetings and reimbursement of NCQA fees after achievement of NCQA recognition. The Pay for Performance component of the program had two and three levels of payment that varied during the three years of the pilot. Expected payouts over three years will exceed $4.2 million.

The pilot group was diverse with respect to geography, practice mix and location. There were 249 physicians in the Pilot and, of these, 100 received PPC recognition, 73 received DPRP recognition and 100 received HSRP recognition by March 2009 (some physicians received multiple recognitions).

Although the clinical results of the study are based on a small number of patients and indicate the need for further accrual to reach statistical significance, the results are encouraging. Physicians recognized in the DPRP and HSRP programs of NCQA were slightly (though not significantly) better in management of patients with diabetes and cardiovascular disease, but they were significantly better in achieving blood pressure control of diabetics. Moreover, the performance of physicians who had not achieved recognition by these programs exceeded HEDIS benchmarks, thus indicating that the "reach" of the pilot program extended to other physicians in the state. The patients of physicians who received PPC recognition were noted to have fewer high cost radiology services, fewer ER visits and fewer specialty visits. This resulted in lower total costs of care for patients of those PPC-recognized physicians compared to patients of non-recognized physicians.

With its use of the BTE model and NCQA recognition programs, BCBSNC was able to reach high levels of achievement through its dedicated efforts and serves as a model for other Plans.

Program Contact: Larry Fox, Director, Network Quality, 919.765.3913, larry.fox@bcbsnc.com