Blue ribbons & green ribbons: The move from Maine recognition to National recognition programs

MHMC uses performance measurement and public reporting of quality data as one way to help improve the quality of health care. The MHMC has traditionally used “blue ribbons” in its Pathways to Excellence” (PTE) program to recognize Primary Care Practices, including Family Medicine, Internal Medicine, and Pediatrics, that meet specific quality standards for care and outcomes.

MHMC awards PTE blue ribbons based on 3 measures of quality care. Current areas of recognition for adults include:

• Office system quality
• Care and outcomes for patients with diabetes
• Care and outcomes for patients with heart disease

Areas of recognition for pediatrics include:

• Office system quality
• Care and outcomes for pediatric patients with asthma
• Pediatric immunization rates

MHMC anticipates that the PTE will add more measures of quality to its rating systems in the future.

Until this year, PTE blue ribbons were awarded when a PCP practice reported quality data on office systems and clinical outcomes to the MHMC, and successfully met specific quality thresholds, or when practices met quality targets in national quality recognition programs, such as the National Committee on Quality Assurance (NCQA) or the Bridges to Excellence (BTE) program.

Beginning May 1, 2009, the MHMC will be awarding PTE blue ribbons only for practices gaining recognition through one of the national recognition programs (i.e. NCQA or BTE). As of May 1, the PTE program will also begin using “green ribbons” to recognize practices that have previously earned recognition by reporting quality data to the MHMC’s PTE program, or practices that earn recognition through other local (Maine) quality recognition programs.

PTE Blue Ribbons: Using Two National Recognition Programs

1) Bridges to Excellence (BTE)

Bridges to Excellence (BTE) is a national program that recognizes the quality of physician care based on self-reported, audited clinical data. Physicians can be recognized through multiple BTE programs, including programs recognizing excellence in office systems, and care for patients with diabetes, heart, and spine conditions. Learn more about Bridges to Excellence at www.BridgestoExcellence.org.

2) National Committee for Quality Assurance (NCQA) – Physician Recognition Programs

The National Committee for Quality Assurance (NCQA) is another national organization that recognizes the quality of physician care based on self-reported, audited clinical data. NCQA has developed recognition programs that recognize excellence in office systems and for care of patients with diabetes, heart, and spine conditions. NCQA recognition programs and measures are similar to the BTE recognition programs (in fact, BTE currently uses the NCQA’s Physician Recognition programs for their diabetes and cardiovascular recognition programs). Learn more about NCQA at: www.NCQA.org.

National Programs: Physician-level vs. Practice-level Recognition

One challenge in using the national recognition programs for PTE recognition is that the both of these national programs recognize physicians at the individual physician level, while PTE recognizes physicians at the physician practice level. The PTE Steering Committee has recommended that we recognize PCP practices that achieve BTE or NCQA program-specific recognition (i.e. awards a PTE “blue ribbon”) when a sufficient number of physicians in the practice receive individual recognition and provide care to most of the patients in the practice – i.e. the practice will be granted PTE “blue ribbon” recognition when NCQA or BTE-recognized providers are providing care for at least 80% of the patients in the practice.

PTE Green Ribbons: Local recognition programs

Beginning May 1, 2009, the PTE program will also begin using “green ribbons” to recognize practices that have previously been recognized for achieving quality targets by submitting data to the MHMC’s PTE program, or to recognize practices through other local (Maine) quality recognition programs.

Green Ribbons for Effective Office Systems

If a practice previously earned a PTE blue ribbon for effective office systems by submitting data using the MHMC’s “Office Systems Survey” in 2007 or 2008, the previous PTE ribbon will be carried over, but will be converted to a “Maine-specific” green ribbon, which will be in effect through March 2010 (using the same 3-year recognition time period used for the NCQA and BTE national recognition programs).

Beginning in 2010, the MHMC may also choose to award PTE green ribbons to practices implementing high-value components of effective office systems, e.g.

• Use of recognized registries for patients with chronic illness
• Electronic prescribing of medications
• Use of care managers to support patients with chronic illness

Green Ribbons for Effective Clinical Care

Beginning May 1, 2009, practices have the option of earning a PTE green ribbon for clinical outcomes in one of 2 ways:

1. If a practice previously earned a PTE blue ribbon by submitting clinical data directly to PTE in 2007 or 2008, their previous PTE ribbon will be carried over, but will be converted to a Maine-specific green ribbon, which will be recognized through March 2010.
2. If a practice has submitted data to the BTE and/or NCQA recognition programs and earned 60-74 points but didn’t meet the threshold of 75 points needed for BTE or NCQA recognition, a PTE green ribbon will be assigned.

Practices should note that PTE green ribbons awarded for clinical data reporting to PTE in 2007 or 2008 will be recognized only through March 2010; after that time, practices wishing to receive a PTE blue ribbon for clinical data submission will need to achieve recognition using one of the national recognition programs (BTE or NCQA).

PTE Recognition: Role of PTE Physician Steering Committee

The MHMC Pathways to Excellence program is led by a Physician Steering Committee made up of physician leaders from around the state. The PTE Steering Committee makes recommendations on awarding PTE blue and green ribbons using nationally recognized quality standards, but also uses their collective best judgment as well. Recommendations from the Steering Committee are brought to the MHMC Foundation Board, which makes the final decisions on PTE award criteria. Physicians on the PTE Steering Committee are aware that current quality standards and measures don’t always tell the whole story of what it means to deliver high quality healthcare, and that these measures cover only a portion of practice behavior and results. The MHMC and the PTE Steering Committee are committed to broadening the criteria for awarding PTE recognition as more quality measures, standards, and reliable data become available.