ORGANIZATION Aetna Inc. is one of the nation's leading diversified health care benefits companies, serving approximately 37.2 million people. PROBLEM OR ISSUE ADDRESSED To increase the number of physicians that are NCQA Diabetes Physician Recognition Program (DPRP) recognized in two pilot regions. GOALS (1) To increase the number of high-volume Aetna contracted practitioners (PCPs) located in targeted geographic areas (South Florida and Southeast PA) with Diabetes Physician Recognition Program (DPRP) recognition (2) To provide physicians with tools to support the delivery and recognition of consistent high quality care. OUTCOMES ITEMS USED IN THE DECISION Clinical efficacy/effectiveness IMPLEMENTATION STRATEGY The Aetna National Quality Management Diabetes Work Group met and agreed on the implementation of a three phase program to increase the number of NCQA DPRP recognized practitioners. Aetna conducted an analysis of two service areas (South FL and Southeastern PA) to rank the high volume Aetna contracted practitioners with the most Aetna members over the age of 18 with a diagnosis of diabetes. The member must have been under the care of the practitioner in calendar year 2007. For the practitioner to qualify he must have at least 25 Aetna members meeting this criteria. Forty practitioners were recruited into the program (20 from each service area). Aetna utilized Total Therapeutic Management (TTM), a research organization, to implement the three phase program. In phase 1, TTM recruited the qualifying practitioners and conducted an in- office chart review to abstract data consistent with the Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set (HEDIS®) measures. TTM utilized its Diabetes Performance and Enhancement Program (DPReP) electronic application to provide the practitioners with a report to see if they met the point criteria for recognition. In phase 2, TTM conducted face-to-face outreach to discuss recognition standing, patient consults (ClinAdvisor), and pharmacy compliance reports. The ClinAdvisor patient consults detailed clinical outcomes such as, A1C, BP, LDL goal, etc. Also during the visit Aetna-developed tools were provided such as chart stickers, eye exam report forms, and 3-year diabetes checklist to promote quality improvement in tracking and managing members with diabetes. TTM communicated with the practitioner during the six-month waiting period in areas that needed improvement. In phase 3, TTM conducted chart reviews based on the criteria set forth by NCQA. TTM input the abstracted data into its electronic application to evaluate recognition status. RESULTS In order to achieve diabetes recognition, practitioners must have a cumulative score of 75 points or more from ten measures related to diabetes care. Of the 40 practitioners that participated in the program four had the potential points necessary to meet the recognition standing score of 75 points in the initial evaluation. After the second review conducted approximately six months after the first review, 18 practitioners agreed to participate in phase 3. Of the 18 practitioners participating, 17 practitioners met the criteria for DPRP recognition. LESSONS LEARNED Practitioners are aware of the benefits of Pay for Performance initiatives. They are also aware of the various recognition programs available through NCQA. Practitioners have expressed concern about the time or office staff necessary to conduct their own chart reviews and submit the application to become a recognized provider. If there is a process in place to conduct chart reviews and provide chart review-based recommendations and other practitioner tools, there is a strong possibility that more practitioners can meet the requirements set forth by NCQA to become a DPRP recognized provider for diabetes and other conditions.