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Physician Office Link

The Physician Office Link program relies on the National Committee for Quality Assurance's (NCQA) Physician Practice Connections (PPC) to assess performance. Meeting PPC standards means that practices have links - to information, patients, to other practitioners, to evidence - that better allow them to manage and provide patient care. The links in PPC take several forms, and NCQA evaluates three overlapping categories of standards in measuring physician office practice performance.

• Clinical Information Systems/Evidence-Based Medicine
  • Basic patient registries and follow-up
    
  • Electronic patient registries and systems for prescribing drugs and tests
  • Partial electronic medical record
• Patient Education and Support
  • Educational resources
  • Referrals for risk factors and chronic conditions
  • Quality measurement and improvement
• Care Management
  • Care of chronic conditions
  • Efforts to reduce preventable admissions
  • Care of high-risk medical conditions

Physician Selection

CareFirst has partnered with two primary care physician practices serving significant numbers of CareFirst members. "Early adopter" practices who have already agreed to participate in the BTE program are:

• Washington Primary Care Physicians - a member of MedStar Physician Partners, located on Capitol Hill in Washington, D.C.
  
  
• Johns Hopkins Community Physicians - located in Wyman Park in Baltimore, Maryland

Funding has been allocated to cover 16,000 CareFirst members as part of the BTE project. From 8 to 12 physician practices will be enlisted. CareFirst is seeking to partner with practices serving diverse patient populations throughout its Northern Virginia, Washington, D.C, and Maryland service area.

Physician Fees and Rewards

Measurement of performance under the Physician Office Link (POL) program is conducted by the respected, independent NCQA. Physician practices participating in the POL must undergo a survey and be certified by NCQA. Certification costs range from $360 for a single practitioner up to $5,000 for physician practices with more than 16 doctors.

As part of its program, CareFirst will reimburse certification costs for participating physicians. In addition, CareFirst nurses and administrative staff will provide training, mock surveys and other services to assist physician practices in demonstrating compliance with NCQA standards.

Physicians who demonstrate compliance with some or all of the components of POL can earn rewards of up to $50 per patient per year. Individual physicians can earn up to $20,000 in the first year, and $50,000 over three years. The maximum annual award for any single practice site is $100,000. Incentives are also built into the program to encourage physicians to demonstrate compliance with more components of the POL in each year of the program.

CareFirst will also recognize participating physicians on its Web site and in its provider directory.

Program Roll Out

CareFirst is actively recruiting more physician practices to participate in its BTE program. The two early adopter practices that have agreed to participate will shortly begin the certification process.

Physician practice recruitment will continue in the first quarter of 2005. CareFirst's goal is to have all participating practices identified and certified before the end of the year.

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