Reminder: Changes to the PGIP allocation will support Organized Systems of Care efforts

As we announced in the April and September 2018 issues of The Record, the Physician Group Incentive Program allocation increased from 5 to 7 percent of the allowed amount in July 2018 to help fund new PGIP Organized Systems of Care initiatives.

Blue Cross Blue Shield of Michigan is now taking the next step in its journey by creating the 2019 PGIP Risk-Bearing OSC program. Starting Jan. 1, 2019, the 7 percent PGIP allocation will be directed as follows:

• Blue Cross will direct 2 percent to fund the 2019 PGIP Risk-Bearing OSC program. This new program rewards OSCs for managing the benefit cost trend of their attributed Blue Cross PPO patient population and is the first step in our pathway to risk strategy.

• The remaining 5 percent will continue to reward eligible physician organizations and OSCs for improving the quality of patient care, system and practice transformation, and reducing costs.

In addition, the PGIP allocation will apply to most professional procedure codes regardless of the billed provider charge, effective Jan. 1, 2019.

Also, as of April 1, 2019, providers will see a new voucher message that represents each of the allocations. There is no change in the overall percentage.

Providers contractually agree in their participation agreements to allocate a portion of their reimbursement to the PGIP fund. All funds allocated are distributed to physician organizations and OSCs that participate in PGIP to support physician practice and system transformation. No money is retained by Blue Cross for administrative costs.

For more information about PGIP, go to bcbsm.com/provider/value_partnerships/pgip.

Note: Claims for Federal Employee Program^® members are excluded from the PGIP allocation.