Value Partnerships Overview

Blue Cross Blue Shield of Michigan works with practitioners, physician organizations and acute-care hospitals in the state to improve the health care for Michigan residents.

This innovative approach to transforming health care:

  • Enhances the quality of care
  • Decreases complications
  • Manages costs 
  • Eliminates errors 
  • Improves health outcomes 

The Value Partnerships program includes several key elements:

Physician Group Incentive Program:

The Physician Group Incentive Program helps practitioners build high-performing, health care systems across the state.

The program brings together physician organizations and encourages them to share information on various aspects of health care. This approach supports and rewards system transformation and population-level management. Practitioners work with their physician organizations to better manage their patients and build a system that better measures and monitors their quality of care.

Primary care physicians and specialists work together on nearly 20 initiatives to improve the health care system. Each initiative, which includes the Patient-Centered Medical Home program, offers incentives based on clearly defined metrics for improving performance and for participation in the program.

The program has more than 40 POs, who represent more than 19,000 primary care physicians and specialists throughout the state. The Physician Group Incentive Program has a presence in all but one of Michigan’s 83 counties. The program positively impacts the lives of nearly two million Blues members and many other Michigan residents, since it has an all-patient approach.

For questions on the PGIP program, please email your provider consultant. Start on this page to contact your provider consultant.

 

Collaborative Quality Initiatives:

We address some of the most common and costly areas of surgical and medical care through the Collaborative Quality Initiatives program.

Participating hospitals and providers collect, share and analyze data through clinical registries. Then they design and implement changes to improve outcomes of complex, technical areas of care. CQI registries allow for a more robust analysis of the link between processes and outcomes than can be achieved by examining one group or institution alone.

As of 2017, BCBSM funds 17 Collaborative Quality Initiatives. Our hospital-based CQIs are focused on hospital care that is technically sophisticated and involves the use of evolving technology and practices. Our professional CQIs primarily look at improving patient treatment plans and care processes.

This award-winning model is the first of its kind nationally. It’s highly regarded as an innovative approach to improving health care quality and value. Findings from the initiatives have been extensively published in medical journals and have earned national recognition and awards.

CQIs let providers self-assess and optimize their care by identifying opportunities to develop best practices or bring current health care procedures into closer alignment with existing best practices. This leads to improved quality and lower costs for certain high cost, high frequency and highly complex procedures.

Through the CQI program, BCBSM works with about 90 hospitals in Michigan. Approximately 90 percent of eligible Michigan hospitals participate in at least one CQI. Hospital CQIs examine care given to nearly 500,000 Michigan patients a year. The professional CQIs involve the collective participation of hundreds of PCPs and specialists.

For questions on BCBSM’s CQI program, please email your provider consultant. Start on this page to find your provider consultant:

 

Hospital Pay-for-Performance:

The Pay-for-Performance program rewards hospitals for improvement and achievement in quality and efficiency. This approach shifts from the traditional fee-for-service to a fee-for-value model. The structure and measures of the P4P program are developed in collaboration with hospitals through a Blue Cross Blue Shield of Michigan-Hospital Pay-for-Performance workgroup.

For questions on BCBSM’s Hospital Pay-for-Performance program, please email ValueContracts@bcbsm.com.

 

Value-Based Reimbursement:

The delivery of health care is undergoing significant changes. It’s moving from a fragmented fee-for-service system with poorly aligned incentives, to a value-based system that rewards collaboration and population-based improvement. 

BCBSM’s value-based reimbursement model gives hospitals the potential to share year-over-year savings based on their efforts to keep population-level costs down while being more efficient in the services they offer.

BCBSM focuses on population-based performance because health care change moves faster when all providers—responsible for a common patient population—are given an incentive that’s earned through better care coordination. 

For questions on BCBSM’s Value-Based Reimbursement with our hospital partners, please email ValueContracts@bcbsm.com.  

Blue Cross Blue Shield of Michigan, Value Partnerships