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July 2017
Blue Cross offering new value-based reimbursement for hematologists and oncologists in 2018
Value Partnerships continues to identify new ways to reward physicians for improving the overall value of health care for our members.
Background
Since 2009, Blue Cross Blue Shield of Michigan has been providing value-based reimbursement opportunities for physicians participating in the Physician Group Incentive Program. During the past several years, we’ve introduced more value-based reimbursement opportunities for more physician specialty types. And during the next one to two years, PGIP-participating specialists should continue to see additional value-based reimbursement opportunities tied to specialty-specific clinical measures.
VBR for hematologists, oncologists
We’re currently developing a new value-based reimbursement program for hematologists and oncologists who participate in PGIP’s Michigan Oncology Quality Consortium.
The Michigan Oncology Quality Consortium is a statewide collaborative quality initiative that focuses on improving the quality of care for cancer patients. MOQC collects clinical data through the American Society of Clinical Oncology’s Quality Oncology Practice Initiative. It uses the results to improve outcomes and patient care. Practices across the state participate in MOQC by:
- Submitting Quality Oncology Practice Initiative data to the MOQC Coordinating Center (housed at the University of Michigan)
- Attending regional and biannual meetings focused on sharing data and improvement
- Participating in quality initiatives
Blue Cross, MOQC Coordinating Center leadership and participating physicians collaborated to develop a set of quality and performance measures tied to value-based reimbursement for MOQC participants. The MOQC-participating practices will be evaluated for value-based reimbursement on the following Quality Oncology Practice Initiative measures:
- Pain addressed appropriately by second office visit and during most recent office visits (target 78 percent) and during end of life (target 80 percent)
- Tobacco cessation counseling administered or patient referred in past year (target 45 percent)
- Hospice enrollment, palliative care referral or services, or documented discussion (target 70 percent)
Performance measurement
Performance will be measured at the regional level. This means that all MOQC participating practices in each designated MOQC region will work together to improve performance across the region.
The regions have been defined by the MOQC Coordinating Center and based primarily on geography and other shared characteristics, and are composed of eight to 15 practices per region. All MOQC-participating oncology practices are aware of their associated regions.
Starting March 1, 2018, oncology practices within a region have the potential to receive 103 percent of the standard fee schedule if their region meets or exceeds target performance on each of the above three measures. If the practice is already receiving 105 percent or 110 percent of the standard fee schedule for performance on population-level measures of cost and quality, the MOQC value-based reimbursement represents an additional 3 percent.
The value-based reimbursement fee schedule for hematologists and oncologists is applied only to commercial PPO claims on all relative value unit based codes. The tables below illustrate how the MOQC value-based reimbursement will be applied and the measurement and reimbursement period.
Blue Cross value-based reimbursement
for oncology (standard population-level VBR approach) |
New MOQC
value-based reimbursement |
|
Ranked in top third of PGIP participating
oncology practices |
Ranked in second third of PGIP participating oncology practices |
Ranked in bottom third of PGIP participating oncology practices |
In MOQC;
MOQC region met target |
Percent of standard fee schedule |
|
|
x |
|
100 percent |
|
|
x |
x |
103 percent |
|
x |
|
|
105 percent |
|
x |
|
x |
108 percent |
x |
|
|
|
110 percent |
x |
|
|
x |
113 percent |
Measurement period for initial MOQC-related value-based reimbursement |
Reimbursement period (applicable to claims for the dates of service below) |
March 1, 2017 – Dec. 1, 2017** |
March 1, 2018 – Feb. 28, 2019 |
** This measurement period may change for subsequent periods.
To receive MOQC value-based reimbursement, practices must:
- Participate in PGIP.
- Fully participate in the collaborative. MOQC collaborative participants must meet Collaborative Quality Initiative participation and performance requirements, which include contribution of data to the QOPI registry.
For more information
- For more details on value-based reimbursement criteria, see these 2016 Record articles:
- To learn more about MOQC, go to moqc.org.***
- To learn more about the American Society of Clinical Oncology’s Quality Oncology Practice Initiative, go to instituteforquality.org.***
- If you have questions about the information in this article, send an email to Marc Cohen, manager, Value Partnerships, at CQIprograms@bcbsm.com.
***Blue Cross Blue Shield of Michigan doesn’t own or control this website. | 
