Who governs BQA?
BQA is owned by the Baylor Health Care System (BHCS) through its controlled affiliates. It has a 19-person Board of Managers, including 14 practicing physicians, three BHCS executives, a community representative, and a BHCS Board member. The BQA Board chairman is a practicing physician, and all the physician Board members were selected by their respective hospital medical staff communities to represent all parts of the BHCS system.
Click here for a list of current Board members.
Is BQA a Medicare-contracted Accountable Care Organization (ACO)?
Not at this time. The Affordable Care Act, enacted by Congress in 2010, provides for the Medicare Shared Savings Program (MSSP) which will allow Medicare to contract with eligible ACOs starting in 2012. Given widespread, fundamental concerns about the feasibility of the MSSP as contemplated by the proposed regulations issued earlier this year by CMS, at this time BQA does not intend to seek the status of a Medicare-contracted ACO. Final MSSP rules are due soon from CMS, and the Board of BQA will revisit the feasibility of participation in the MSSP once those rules are published. Meanwhile, BQA intends to continue with the work of developing an accountable care organization in which all of its provider participants are committed to the goals of higher quality and lower overall cost of care, through effective clinical integration.
Can any physician be a member of BQA?
The membership is open at this time to any physician wishing to be joined with BHCS and its clinical partners in an accountable alliance to improve quality, reduce costs, and clinically integrate care of our patients.
Is there a fee to be a BQA member?
Yes. A fee will be required of all physician participants to cover costs of credentialing and basic organization. Committee participation in BQA committees can quickly offset actual out of pocket costs for those physicians who will participate in the formation of its clinical integration structure.
I am a primary care physician. What are some of the advantages to joining BQA?
Most health care reform proposals strongly encourage all patients to have a medical home. BQA will assist primary care physicians in becoming NCQA Patient-Centered Medical Homes, a designation which can improve rewards and attract patients. Other practice management resources can be available as well to assist practices in today’s difficult business environment.
For more information, click here for the document "Joining BQA."
I am a specialist. What are some of the advantages to joining BQA?
The value added benefits of joining BQA include participation in creating and excelling in the clinical integration world of tomorrow. By dedicating yourself to a common mission, with like-minded providers, dedicated to the goals of improved quality and reduced cost through effective clinical integration, BQA membership will create a firmly linked position in a care network or “Medical Neighborhood.”
For more information, click here for the document "Joining BQA."
Are there potential financial rewards to clinical integration?
Given the current and projected health care spending constraints, there will likely be no rewards to physicians and hospitals that do not commit themselves to improving quality while reducing costs through effective clinical integration. In fact, reductions in revenues are clearly on the horizon for both doctors and hospitals. However, most payers appear willing to reward cost effectiveness if accompanied by high quality and good patient satisfaction.
What are the benefits of joining? The elevator speech that I can tell my partners/colleagues.
Benefits include: (1) Participation with a clinically integrated organization that shares patient information via electronic health record shared through a health information exchange for contracts that offer shared savings, bundled payment, or other new payment methods; (2) Participation in development of clinical best practice integration and evidence-based care paths; and (3) Being identified with a brand supporting quality, reducing waste, and decreasing health care costs.
How do you bring in New Technology into this equation? For example, for certain specialties, CV services technology advances.
There will have to be a place for innovation in the health care of the future, the system cannot support going backward in advancing best care. BQA will have a voice in developing the cost/benefit to our hospital partners – who make many of the technology decisions - as well as how to appropriately distribute reimbursement, relative to bundled payments.
How do you project the Shared Savings curve? Growth? For how long.
Intuitively, we expect that as the costs are reduced, and shared savings are gained a plateau will be reached. How savings will grow and for how long is still to be projected. Some would say that the health care system will in the future move to a bundled payment and/or capitation model.
Who are the owners?
BQA is a for profit organization with the BHCS non-profit hospitals as owners.
Are there incentives/disincentives to keep patients within the BQA network?
We believe that a participating physician will want to keep patients within the BQA network to assure quality and manage the costs for patient care, and also we believe that health benefit insurance plans supported by the BQA employer and payer contracts will also incentivize the patients to stay within the BQA network and further encourage their physicians to look for services within the network. We believe through clinical integration, that BQA primary care and specialty participating physicians will want to remain within the care stream via the health information exchange to improve access to patients within their practice.
Will my performance be measured by the percentage of my patients that stay within the network?
There are a number of options being considered for performance measures. Under consideration are the 33 Core Measures required by the Medicare Shared Savings Program. Also, a study is underway of other similar clinically integrated organizations on performance measures. In some cases, it may make sense to measure a physician performance based on network utilization but that is not clear at this time. Any such measure, provided it is consistent with applicable law, would need approval by the appropriate BQA Committee(s) and the BQA Board.
How do you address groups when all members are not part of BQA; i.e. performance measures, care paths.
Currently the panel is open; however, all members of groups will not be required to be a part of BQA. The group itself will sign a participation agreement and those physicians from the group who choose to participate will each sign an acknowledgement agreement to memorialize their agreement to comply with the terms of the participation agreement, including being measured for performance and complying with care paths.
What data is being monitored? PQRS data? Inpatient and Outpatient?
The BQA IT and Best Care / Clinical Integration Committees are studying which data will be available to the BQA and how the data will be able to be accessed, congregated, and reported.
How do you address ancillary (lab, imaging, etc) “self utilization”? Will ancillary services also be “credentialed” to be part of BQA?
Physician participants and ancillary services will be credentialed separately. Each scenario for self-utilization and ancillary credentialing will be considered on a case-by-case basis. Criteria will be established by the Membership and Standards Committee for credentialing, and certain criteria such as quality, best care practices, as well as cost savings will be considered.
How will BQA support care coordination? What are the care coordination requirements for the participant physician offices?
BQA has an ad hoc study group looking at the care coordination needs through our Best Care / Clinical Integration and Population Management Committees. There are some best care examples in the community that have shown some successful results, allowing health care practitioners to work at the top of their licenses. The other important questions for care coordination are what is the best utilization of resources available and where is the best place for the care coordination to reside. More information will be coming to the participants as we progress.
Will BQA integrate all of the BHCS committee resources? For example, Best Care, HTPN, etc.
Yes, BQA will use its best efforts to integrate all relevant BHCS committee resources and not duplicate time, costs, or efforts.
How will the hospitals reconcile the idea that utilization may be reduced, and specialty volumes may be reduced?
We recognize the current health care crisis of rising costs, and duplication/waste. Hospitals and physicians understand that improved quality of care produces less utilization, in some specialties this has already occurred. We have some options to reduce significantly fixed costs through clinical integration.
How do we manage physicians that do not follow care paths and best care protocols?
All participating physicians will expressly agree to follow best care practices and care paths. If some do not, the results will be determined by their peers on the various committees and the Board. Following attempts at education, non-compliant individuals may be asked to leave based on results of performance measurements of quality, cost, and best care practices.
Why have open panels for the network? Why not hand pick physicians and certain specialties?
The idea is to be inclusive, with broad primary care and specialty panels. The Membership and Standards Committee and the BQA Board will monitor enrollment and recognize that at a point in time in the future the panel may be closed.
What is in it for the patient? How do we incentivize patients?
Improved clinical integration will have a natural outgrowth of clearer navigation for services for the patient. We are already beginning to see health plans directing patients and encouraging in network care by means for financial incentives like copayments and payments for participation in exercise and/or prevention programs.
How do you manage a large influx of patients? Perhaps, sicker patients, and Medicaid patients that put stress on the system?
The BQA Population Management Committee and others within BHCS are already studying this issue and pilot projects are underway to find ways to better serve populations, ways to facilitate the organization of health care resources and workers to work at the top of their license, and ways to advance innovation medicine like telemedicine and care coordination.