We have new value-based reimbursement opportunities for specialists participating in CQIs

As part of our continuing efforts to transform reimbursement from the traditional fee-for-service to fee-for-value, we have five new Collaborative Quality Initiatives value-based reimbursement opportunities that reward specialists for improving quality of care through performance in our CQIs, effective March 1, 2018.

Value Partnerships initially launched the CQI VBR in 2017 with the Michigan Urology Surgery Improvement Collaborative, which is also continuing in 2018, to reward MUSIC physicians for reducing infection rates and unnecessary biopsies in prostate cancer patients across Michigan.

As a result of this successful endeavor, and to strengthen our fee-for-value approach, we’re launching CQI VBR for the following CQIs for the 2018 VBR reimbursement period:

• Anesthesiology Surgery Performance Improve & Reporting Exchange Collaborative, also known as ASPIRE
• Blue Cross Blue Shield of Michigan Cardiovascular Consortium, also known as BMC2
• Michigan Anticoagulation Quality Improvement Initiative, also known as MAQI2
• Michigan Surgical Quality Collaborative, also known as MSQC
• Michigan Oncology Quality Consortium, also known as MOQC

The coordinating centers that run the operations for the CQIs listed above developed measures and a scoring method, in collaboration with consortium clinical leadership, which were approved by Blue Cross for use for the 2018 VBR period. Each CQI uses a unique scoring method that best fits its collaborative. Performance is measured and scored at one or more of the following levels:

• Affiliated hospital – Physician performance is grouped by the collective average of the physicians at their primary hospital (affiliation determined by the coordinating center and consortium members).
• Affiliated physician organization – Physician performance is grouped by the collective average at the PO.
• Collaborative-wide – Physician performance is based on the collective average of all physicians.
• Regional – Physician performance is assessed at a regional level.
• Physician practice – physician performance is based on the collective average at the physician practice.

The measures for each CQI are listed in the table below and reflect clinically relevant data that is abstracted into each CQI’s registry. Physicians who meet the performance expectations of their affiliated CQI will receive 103 percent CQI VBR, which is in addition to any specialist VBR opportunity available through the Physician Group Incentive Program. The CQI VBR reimbursement period will follow the same reimbursement period as other specialist VBR. The CQI VBR also follows the same guidelines as the specialist VBR.

• The physician must be enrolled in Blue Cross’ PGIP program through one of the affiliated PGIP physician organizations for at least one year.

Unique to CQI VBR are the following guidelines:

• The physician must be contributing data for at least two years in the respective CQI’s clinical data registry (with at least one year worth of baseline data) to be considered eligible (specific to CQI VBR).
• The physician isn’t nominated by the PO for CQI VBR. Instead, the CQI coordinating center notifies Blue Cross of which physicians meet the performance targets based on the scoring entity mentioned above (i.e., affiliated hospital, affiliated PO). The PO is responsible for notifying physicians who receive VBR, similar to the specialist VBR.

In some cases, physicians may be participating in more than one CQI. For those instances, physicians are limited to receiving 103 percent VBR for CQI performance. For example, if a physician participates in both the BMC2 and MSQC CQIs and the physician’s performance is such that he or she would be eligible for CQI VBR for both, the physician will receive 103 percent VBR.

** There are targets set for each of the measures developed by their respective CQI coordinating center with approval from Blue Cross.