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Developing a Statewide Diabetes Care Physician Incentive Program Among Payers

  • By: NYSHealth
  • Date: October 2011
  • Priority Area: Diabetes Prevention and Management
  • Type: Grant Outcome Reports
  • Category: Grant Outcome Report
  • Document: Download
  • Grantee Name: Bridges To Excellence

Overview

In 2008, NYSHealth established a five-year, $35 million Diabetes Campaign to reverse the diabetes epidemic. The Campaign focuses on improving clinical care and patient outcomes; mobilizing communities to prevent diabetes and support diabetes self-management; and promoting policies that sustain comprehensive and effective care for people with diabetes. A range of demonstrations and studies show that patients have consistently better health outcomes when physicians improve their practices. Well-designed and standardized incentive payments have also been documented as motivating physicians to improving their practices. Yet in New York State, there is a lack of a common framework among payers for developing, measuring, or paying incentives. The Bridges to Excellence (BTE) grant supported the Foundation’s efforts to promote payment incentives for primary care physicians that would ultimately improve the quality of care delivered to patients at-risk for or diagnosed with diabetes.

Grant Goals:

BTE hoped to achieve the following goals:

  • Provide technical expertise for the purpose of getting all or the majority of payers in New York State to pay incentives that encourage primary care physicians to increase the quality of care they deliver to patients with diabetes.
  • Leverage existing pay for performance (P4P) activities in the State by private and public sector payers.
  • Gain consensus from health plans and other stakeholders on evidence-based measures for diabetes care.
  • Encourage health plans to reward physicians that do well in diabetes care.
  • Allow for multiple pathways for physicians to demonstrate to health plans that they are delivering high-quality care, considering those pathways include the core set of diabetes care quality measures.

Grant Outcomes:

BTE accomplished the following:

  • Developed a survey of health plan-based P4P efforts to evaluate if the plan’s rewards and recognitions for physicians delivering good quality care to patients with diabetes met criteria as defined by the project team.
  • Encouraged payers to offer incentives to providers that had successfully met the criteria for the National Committee for Quality Assurance (NCQA) or BTE diabetes recognition.
  • Worked through the Endorsement Survey with 13 private and public sector health plans and yielded a number of Endorsements and/or commitments from plans to deliver financial incentives to physicians recognized for delivering quality care.
  • Worked with the Healthcare Association of New York State (HANYS), to facilitate the submission of medical record data from Montefiore practicing physicians.

Related Story: Health Care Providers Improve Diabetes Care for Patients

Grantee Information:

Download Grant Outcomes Report