Blue Cross Blue Shield of Michigan welcomes specialists into incentive program, begins formulating Organized Systems of Care

Collaboration between insurer and physicians answers call for accountable care organizations

August 10, 2011

DETROIT — Collaborations among physicians, health care providers and Blue Cross Blue Shield of Michigan continue to grow, as the insurer opened its Physician Group Incentive Program to all specialists this summer to prepare for additional health care improvement initiatives for Michigan residents.

Since 2005, the PGIP program has encouraged primary care physicians and those specialists who care for patients with common chronic illnesses to deliver quality, cost-effective care to patients. The Patient-Centered Medical Home Program, which improves the way primary care physicians partner with their patients to improve their health, is part of PGIP. With specialists, including podiatrists and chiropractors, on board, physicians will work together to develop and use shared information systems and processes of care, as well as sharing responsibility for the health outcomes of a group of patients. This marks the beginning of the Blues’ Organized Systems of Care Program – its version of the accountable care organizations that are included in the national Affordable Care Act’s Medicare Shared Savings program effective January 2012.

“This is a logical extension of the Patient-Centered Medical Home model, which focuses on improving patients’ health through improved care processes and more coordinated relationships between patient and primary care physician,” says David Share, M.D., M.P.H., vice president of Value Partnerships at Blue Cross Blue Shield of Michigan. “The natural extension is for these PCMH practices to integrate patient care with specialists, using shared systems and processes so that patients’ health is managed across all stages.”

In this early stage of Organized Systems of Care development, about 5,330 physicians in 39 groups have expressed interest in participating in BCBSM’s OSC program.

In July 2011, BCBSM launched two specific initiatives designed to help build OSC infrastructure.

The first initiative supports systemwide integration of patient registries. This will allow each OSC to have a complete data set of their patients, which helps with tracking and coordinating care.

The second initiative supports OSC tracking and reporting of performance measures such as patient health outcomes.

“We are closely collaborating with physicians to develop the parameters of this program, giving them wide latitude in how they transform their systems of care,” says Dr. Share. “Blue Cross expects each OSC to be responsible for delivering well-coordinated, efficient, high quality health care to its group of patients. But how they go about doing that is not for us to dictate.”

Blue Cross expects to launch a full OSC program in 2013. Participating OSCs will earn a greater portion of reimbursement tied to participation and performance.

The overall goal of the OSC program is to create a high performing health care system, by strengthening the primary care foundation; increasing clinical integration among primary, specialty and facility-based care; decreasing variation in care; decreasing fragmentation in care processes; improving care quality and improving health outcomes for patients.

The OSC program is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, go to valuepartnerships.com.

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. For more company information, visit bcbsm.com.