PGIP 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.
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 Blue Cross Blue Shield of Michigan. 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
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 Blue Cross Blue Shield of Michigan claims payment voucher.
Blue Cross Blue Shield of Michigan 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.
As of July 1, 2013, the amount used to fund the PGIP incentive program is 5 percent of nearly all professional reimbursement. This amount is in addition to the amount paid to individual providers for their services.
Blue Cross Blue Shield of Michigan 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 Blue Cross Blue Shield of Michigan 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 Blue Cross Blue Shield of Michigan for administrative costs.