How We Choose Providers for Our PPO and EPO Networks

What is this about?

If you'd like more information about how we choose the doctors, hospitals and health care professionals for our networks, you can find that here.

Blue Cross Blue Shield of Michigan follows credentialing and quality standards set by the National Committee for Quality Assurance and the National Quality Forum.

When choosing providers to include in our PPO network, we also review their performance using measures from appropriate state and/or national accreditation guideline programs.

Doctors and hospitals don't have to take part in quality programs or meet specific measures for member service before joining our network. We make sure our members get the best care by rewarding our network providers for taking part in quality activities.

We require our network hospitals to participate in quality activities at least once every 18 months, including:

  • Leapfrog Hospital Survey
  • Joint Commission Periodic Performance Review of National Patient Safety Goals
  • Agency for Healthcare Research Patient safety indicators
  • Federally-qualified patient safety organization

We reward our network doctors and health care professionals for quality and efficiency performance in any of the following programs:

  • Patient Centered Medical Home, or PCMH
  • Physician Group Incentive Program, or PGIP
  • Patient Centered Medical Home Neighbor for specialists

All of these programs include measure related to preventive health (immunizations and screenings for cancer), chronic conditions (diabetes, asthma, COPD) and member satisfaction.

Learn more about our PPO and EPO networks and how we select them below.