1. Incentives Institute October 20th 2008
BTE’s Lessons
Incentives Institute
October 20th 2008
François de Brantes, CEO
Bridges To Excellence

2. Uncertainty and the Welfare Economics of Medical Care
“Since the patients do not, in their belief, know as much as the physician, they cannot completely enforce standards of care. In part, they replace direct observation by generalized belief in the ability of the physician. To put it another way, the social obligation for best practice is part of the commodity the physician sells, even though it is a part that is not subject to thorough inspection by the buyer.” Kenneth J. Arrow, 1963

3. BTE’s goal has been to solve one of the many information asymmetries
Recognized physicians have been reviewed by independent third party organizations
Recognized physicians have to demonstrate that they are actually delivering good results
Recognized physicians become highlighted in provider directories and other consumer reports to help consumers identify who’s adhering to standards
But…you can’t get physicians to become recognized without incentives, because the fee-for-service system militates against taking on complex patients

4. Lessons Learned (in addition to It Works)
Measure what matters – processes and outcomes that are tightly linked to patient risk reduction 1, 2 (e.g. BP control) – and aim for excellence (
Collaborate for a common good (plans acting individually rarely succeed 3, 4) to create a critical mass of incentives (practice transformation is expensive) that pay off 5
Eddy et al, “The Potential Effects Of HEDIS Performance Measures On The Quality Of Care”, Health Affairs 09/2008
de Brantes et al, “The Value of Measures in Ambulatory Care”, AJMC 06/2008
Pearson et al, “Impact of P4P on Health Care Quality in MA”, Health Affairs 07/2008
Rosenthal et al, “Climbing up the P4P Learning Curve”, Health Affairs 11/2007
Rosenthal et al, “BTE: Recognizing High Quality Care”, AJMC 09/2008

5. The juice has to be worth the squeeze
Likelihood of Physicians participating in BTE’s Diabetes Care Link
Likelihood of Physicians participating in BTE’s Physician Office Link

6. Plans can only optimize the impact of their incentives by collaborating
The more “covered lives” there are in a medical trading area the greater the likelihood physicians will participate in the incentive program and all will benefit.