Bridges to Excellence

Description | Challenge | Solution | Outcomes

Description

Diabetes is the 6th leading cause of death in the United States. An estimated 20.8 million Americans have diabetes, including 6.2 million who don’t know it. Another 41 million are pre-diabetic, a condition that will likely progress to diabetes without appropriate preventive treatment. An additional concern is the increase in obesity – a major risk factor in developing diabetes.

Based on data for the year 2002, the economic cost of diabetes was $132 billion: $92 billion in direct medical costs and $40 billion in indirect costs such as lost workdays and restricted activity. The average expense for a diabetic was $13,243 or 5.2 times greater than the expense for a non-diabetic.

Challenge

Unfortunately diabetics only receive appropriate treatment fifty percent of the time. Public awareness about the seriousness of the disease and the importance of its management is low even though it is one of the leading causes of death and disability in the U.S. Unless changes occur, the Centers for Disease Control (CDC) estimates 1 of 3 Americans born in 2000 may develop diabetes. The outlook may be even more dismal for minorities who are disproportionately impacted.

Solution

Bridges to Excellence (BTE) is a not-for-profit organization developed by employers, physicians, health care services researchers and other industry experts with a simple mission: to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care. One focus of BTE is diabetes care.

Diabetes Care Link enables physicians to achieve one-year or three-year recognition for high performance in diabetes care. To obtain the rewards available through the Bridges to Excellence Diabetes Care Link (DCL) reward program, eligible physicians must demonstrate that they provide high levels of diabetes care by passing NCQA's diabetes performance assessment program.

Qualifying physicians receive up to $80 for each diabetic patient covered by a participating employer and plan. In addition, the program offers a suite of products and tools to help diabetic patients get engaged in their care, achieve better outcomes, and identify local physicians that meet the high performance measures. The cost to employers is no more than $175 per diabetic patient per year with savings of $350 per patient per year.

Outcomes

Independent studies conducted by three national health plans found that physicians participating in the BTE Diabetes Care Link program offered care that was substantially more consistent with best practice guidelines than physicians not participating. The studies also found that these physicians delivered care at a 10% to15% lower cost than non-BTE physicians (Approximately $350 per patient in the initial study year). The majority of the savings came from fewer hospitalizations and fewer trips to the emergency room, which although not considered in the previous savings estimates equates to lower disability costs and higher productivity levels. An analysis by Towers Perrin of the Diabetes Care Link module estimated a maximum savings of $1,059 per patient per year when Blood Pressure, HbA1c and LDL control measures are met.