Blue Cross Blue Shield of Michigan rewards PGIP physician organizations and Organized Systems of Care for system transformation and population level management twice a year.
What you need to know about incentive rewards
An organization’s reward depends on:
- Performance and improvement
- Accomplishing goals with its PGIP physicians
Each organization can decide how to use their reward. For example, some develop infrastructure or give incentives to physicians. We expect them to use the money to further the PGIP goals of improving health care quality and transforming health care value.
All funds from the PGIP reward pool go to the physician organizations and Organized Systems of Care. Blue Cross Blue Shield of Michigan doesn’t keep any funds to cover administrative costs.
How we fund the PGIP reward pool
The PGIP Allocation is used to fund the PGIP reward pool.
- It is a percentage of the applicable fee schedule on most professional paid claims.
- All BCBSM participating providers agree by contract to make an allocation from their reimbursement into the PGIP reward pool.
- PGIP Allocation percentage increases are approved by the BCBSM Chief Medical Officer and may increase each year. Providers will be notified of increases through The Record. The current PGIP Allocation is 5 percent.
- Language on the provider voucher reflects the PGIP Allocation.