Value Partnerships Overview
Blue Cross Blue Shield of Michigan works with practitioners, physician organizations and acute-care hospitals in the state to improve the health care for Michigan residents.
This innovative approach to transforming health care:
- Enhances the quality of care
- Decreases complications
- Manages costs
- Eliminates errors
- Improves health outcomes
The Value Partnerships program includes several key elements:
Physician Group Incentive Program:
The Physician Group Incentive Program helps practitioners build high-performing, health care systems across the state.
The program brings together physician organizations and helps them share information on various aspects of health care. This approach supports and rewards system transformation and population-level management. Practitioners work with their physician organizations to better manage groups of patients with similar medical issues and build a system that better measures and monitors their quality of care.
Primary care physicians and specialists work together on nearly 30 initiatives to improve the system. Rewards are based on clearly defined metrics that track changes in care delivery, improvement in performance and program participation.
The program has more than 40 POs, who represent nearly 18,000 primary care physicians and specialists throughout the state. The Physician Group Incentive Program has a presence in all but one of Michigan’s 83 counties. The program positively impacts the lives of nearly two million Blues members and many other Michigan residents, since it has an all-patient approach.
For questions on the PGIP program, please email your provider consultant. Start on this page to contact your provider consultant.
We address some of the most common, costly areas of surgical and medical care through Collaborative Quality Initiatives program.
Hospitals and providers in the program collect, share and analyze data through clinical registries. Then they design and implement changes to improve outcomes of complex, technical areas of care. CQI registries allow for a stronger analysis of the link between processes and outcomes that can’t be achieved by examining one group or institution alone.
As of 2014, BCBSM funds for 14 hospital-based and 5 professional-based CQIs. Our hospital-based CQIs are focused on hospital care that is technically sophisticated and involves the use of evolving technology and practices. Our professional CQIs mostly look at improving patient treatment plans and care processes.
This award-winning model is the first of its kind nationally. It’s highly regarded as an innovative approach to improving health care quality and value. Findings from the initiatives have been extensively published in medical journals and have earned national recognition and awards.
CQIs let providers self-assess and optimize their care by identifying opportunities to develop best practices. The initiative also brings health care procedures into closer alignment with existing best practices. This leads to improved quality and lower costs for certain high cost, high frequency and highly complex procedures.
Through the CQI program, BCBSM works with about 70 hospitals in Michigan. Ninety-two percent of eligible Michigan hospitals participate in at least one or a variety of hospital CQIs. Hospital CQIs examine care given to nearly 200,000 Michigan patients a year. The professional CQIs involve the collective participation of hundreds of PCPs and specialists.
For questions on BCBSM’s CQI program, please email your provider consultant. Start on this page to find your provider consultant:
The Pay-for-Performance program rewards hospitals for improvement and achievement in quality and efficiency. This approach shifts from the traditional fee-for-service to a fee-for-value model. The structure and measures of the P4P program are developed in collaboration with hospitals through a Blue Cross Blue Shield of Michigan-Hospital Pay-for-Performance workgroup.
For questions on BCBSM’s Hospital Pay-for-Performance program, please email ValueContracts@bcbsm.com.
The delivery of health care is undergoing significant changes. It’s moving from a fragmented fee-for-service system with poorly aligned incentives, to a system that rewards collaboration and population-based improvement.
BCBSM’s value-based contracting model gives hospitals the potential to share year-over-year savings based on their efforts to keep population-level costs down while being more efficient in the services they offer.
BCBSM focuses on population-based performance because health care change moves faster when all the providers responsible for a common patient population are given an incentive that’s earned through better care coordination.
For questions on BCBSM’s Value-Based Contracts with our hospital partners, please email ValueContracts@bcbsm.com.