In the spring of 2006, Blue Cross/Blue Shield of NC announced a new three-year pilot program and invited practices to participate in the Bridges to Excellence Incentive Program. This new program would reward and recognize physicians who met national quality of care standards. Approximately 70 physicians across the state were selected to participate in the program and Goldsboro Pediatrics was invited to participate in the "practice office management" arm of the program that included clinical information systems, patient education and support, and care management.
Blue Cross/Blue Shield NC chose the National Committee for Quality Assurance (NCQA), a private, non-profit organization that accredits and certifies a wide range of health care organizations, to evaluate practices for compliance with quality assurance/improvement guidelines. The doctors at Goldsboro Pediatrics did not have the time nor staff resources to devote to completing the online survey so the practice contracted with a consultant. The consultant had successful experience completing the survey tool in the past. Our practice utilizes electronic medical records but this is not necessary to achieve recognition. Electronic medical records are necessary for attainment of the top level within the NCQA Recognition. The managing partner of the practice devoted around 20 hours to assisting the consultant with obtaining the data needed to complete the evaluation instrument.
The practice scored in the highest level for NCQA's PPC program, resulting in a significant financial payment to the practice. The practice found the program to be based upon multiple practice management "outputs," and some potential outcomes embedded in one part of the program in which the practice had to identify three conditions (otitis media, asthma, ADHD) and demonstrate consistent implementation of clinical guidelines.
NCQA continues to be the "evaluating agency" for the Patient Centered Primary Care Collaborative (PC-PCC) as it brings together health insurance plans, employers, and primary care physician groups to promote better payment of primary care physicians who are providing high quality cost-effective care for patients in a patient-centered medical home.