Value Partnerships Overview
Blue Cross Blue Shield of Michigan's Value Partnerships program is a collection of clinically oriented initiatives that are significantly improving the quality of patient care throughout the state of Michigan.
Through Value Partnerships, Blue Cross Blue Shield of Michigan works collaboratively with physicians, Physician Organizations, and with the majority of the acute-care hospitals in the state to improve the health care provided to all Michigan residents.
This innovative, quality-based approach to transforming health care is:
- Enhancing clinical quality
- Decreasing complications
- Managing costs
- Eliminating errors
- Improving health outcomes
The Value Partnerships program includes several key elements:
Hospital Pay-for-Performance: The Blue Cross Blue Shield of Michigan P4P program rewards hospitals for improvement and achievement in both quality and efficiency. Through this program a hospital earns, on average, an additional 5 percent on all inpatient and outpatient payments. Blue Cross Blue Shield of Michigan also offers a P4P program for small rural hospitals with measures unique to small and critical access hospitals. The structure and measures of both P4P programs are developed in collaboration with hospitals via a Blue Cross Blue Shield of Michigan-Hospital P4P Workgroup.
Physician Group Incentive Program: PGIP is an innovative program that is catalyzing Michigan physicians to create high performing health care systems across the state. This program supports and facilitates practice transformation using a wide variety of initiatives to reward Physician Organizations for improved performance in health care delivery. PGIP is comprised of 34 initiatives aimed at capability building, improving quality of care delivery, and appropriate utilization of services.
Collaborative Quality Initiatives: CQIs address some of the most common, costly areas of surgical and medical care by facilitating collaboration between Michigan providers and hospitals. Participating hospitals and providers collect, share and analyze data through the use of clinical registries, then design and implement changes to improve outcomes associated with complex, technical areas of care. CQI registries permit a more robust analysis of the link between processes and outcomes than can be achieved by examining one group or institution alone. As of 2014, Blue Cross Blue Shield of Michigan is providing funding and leadership for 14 hospital-based CQIs.
PGIP models of care
Patient-Centered Medical Home Program: The PCMH designation program, the largest of its kind in the nation, has experienced steady growth, measureable results and both regional and national recognition. The number of designated PCMH physicians has grown from 995 practices in 2009 to over 1,200 in 2013.
Provider-Delivered Care Management: PDCM is a promising new model for care management delivered in the context of the doctor-patient relationship, which extends care management into the clinical setting. Through this program, multi-disciplinary teams composed of RNs, diabetes educators, pharmacists and other health care professionals, led by primary care physicians, work with patients to ensure that patients are empowered to self-manage their health, and that all gaps in care are addressed.
Organized Systems of Care: OSC is the term Blue Cross Blue Shield of Michigan uses to describe a community of caregivers that has a shared commitment to a defined patient population. OSCs are designed to take Blue Cross Blue Shield of Michigan's PCMH Program to the next level, expanding it to include hospitals and specialists. Together, through the formation and development of OSCs, primary care physicians, specialists and hospitals will work to coordinate services across the health care continuum for a defined patient population.