PGIP allocation amount to increase for most codes

Effective July 1, 2018, the amount of professional fees allocated to the Physician Group Incentive Program will increase from 5 percent to 7 percent.

Our innovative physician incentive program rewards performance and best practices, and is designed to improve the quality of patient care and reduce costs. The increase in the PGIP allocation will be used to fund new PGIP organized systems of care initiatives. There have been no increases in the PGIP allocation since 2013.

Your claims payment vouchers will reflect this change. Instead of reflecting a 5 percent allocation to PGIP, vouchers will now show a PGIP allocation amount of 7 percent of the allowed amount, which is based on the applicable fee schedule. Providers contractually agree in their participation agreements to allocate a portion of their reimbursement to PGIP.

“Aligning with changes to the PGIP allocation, the Blue Cross PPO conversion factors will be adjusted upward by approximately 2 percent,” said Dr. Thomas Simmer, senior vice president and chief medical officer for Blue Cross Blue Shield of Michigan. For details, see the article, also in this issue, titled Blue Cross changing practitioner fees July 1.

Using the same approach that has created the largest Patient-Centered Medical Home program in the country, Blue Cross Blue Shield of Michigan is focused on helping OSCs build infrastructure and integrated care processes so these systems can offer more coordinated care to the population of patients they serve. From the outset, PGIP’s long-term goal has been to encourage primary care doctors, specialists, hospitals and other providers to create high-functioning, comprehensive OSCs, and to support them in their efforts.

An increasing proportion of reimbursement is tied to the development of highly effective systems of care and rewarding provider performance for effectively managing their patient population. All funds from the PGIP incentive pool are distributed to physician organizations and OSCs that participate in PGIP to support physician practice and system transformation. No money is retained by Blue Cross for administrative costs.

For more information about PGIP, go to bcbsm.com/provider/value_partnerships/pgip.
Note: Claims for Federal Employee Program^® members are excluded from the PGIP allocation.