Physician Group Incentive Program (PGIP): Expectations

Incentive reward

This program includes payment to physician organizations for participation and performance improvement in the initiatives selected. Most physician organizations are eligible for both components, depending on the incentive design of the particular initiatives.

Participation reward

Physician organization participation includes involvement in leadership, collaboration with other physician organizations, recruitment of new participants, and the development of new initiatives and projects with BCBSM. Physician organizations may be eligible to receive participation rewards to cover their time, effort and investment in these activities. Leadership opportunities include participation in the following:

• Initiative Teams
• Leadership Committees
• Project Teams
• Interest Groups

Performance reward

The performance payment rewards success in achieving measurable goals as defined in the initiative(s) the physician organization participates in for that program year.

Funding the pool and distributing payment

Here's what you will see on the BCBSM claims payment voucher.

BCBSM pays the physician the approved amount that is based on our established fee schedule.

At the same time, the voucher shows an additional Physician Organization amount for PGIP incentives, which is available to PGIP POs. These are dollars exclusively devoted to the PGIP incentive pool and are NOT intended as fee schedule reimbursement. The dollars are NOT taken out of the approved amount that is paid to the provider.

Combined, they add up to the allowable amount. The allowable amount is our way of tracking – on an individual claim basis – the separate amounts we spend on physician reimbursement and PGIP.

In 2011, Blue Cross Blue Shield of Michigan devoted an amount equal to 4.2 percent of the value of nearly all professional reimbursement to fund the PGIP incentive program. This amount was in addition to the amount paid to individual providers for their services. Over the last five years, Blue Cross has made reward payments to 40 POs across Michigan. These POs represent approximately 15,500 primary care physicians and specialists who are participating in PGIP and working on implementing performance transformation capabilities with a goal of improving quality and patient safety for all Michigan residents.

BCBSM distributes incentive dollars from the PGIP Reward Pool to the PGIP POs twice annually. These incentive dollars are intended to be used by each PO to further the goals, shared by BCBSM and the physician community, of transforming health care systems to achieve optimal health care quality and value. All funds from the PGIP incentive pool are distributed to the POs; no monies are retained by BCBSM for any administrative costs.