Rewards for Specialists

Blue Cross Blue Shield of Michigan identifies and rewards practices that collaborate with their community of caregivers to effectively manage their shared patients. Specialists receive fee uplifts if they collaborate with their Physician Group Incentive Program PO and other practitioners, and if they’re associated with high-quality, cost-effective care. Fee uplifts are an additional percentage added to the standard fee schedule.

Our goals in extending fee uplifts to specialists include:

  • Transforming reimbursement from traditional fee-for-service to fee-for-value
  • Encouraging conversations and collaboration among practitioners, especially between specialists and primary care physicians
  • Accelerating the adoption of Patient-Centered Medical Home-Neighbor principles
  • Supporting and promoting Organized Systems of Care
  • Assessing and improving population-based measures of performance

In 2015, all specialists are eligible for fee uplifts except anesthesiologists. POs nominate specialists who are acting as PCMH-Neighbors. We choose which specialists receive fee uplifts based on optimization of use, cost and/or quality in the PO populations they serve.

We determine eligibility for fee uplifts on an annual basis with an effective date of Feb. 1. To be nominated for fee uplifts, specialists need to participate in PGIP for at least one year.

We only apply fee uplifts to PPO and Traditional commercial claims. We don't apply fee uplifts to claims for ambulance, durable medical equipment, prosthetics and orthotics, anesthesia, immunizations, most injections, or hearing, lab, dental or routine vision services.

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