Blueprint allocation amount of 1.5% to go into effect July 1, 2023

Over the past 18 years, Blue Cross Blue Shield of Michigan has evolved our payment processes to incentivize value over volume. We maintain specific base rates while offering new revenue opportunities through increased incentive payments to health care providers who demonstrate success in delivering care and managing patient health on a population basis. While this pay-for-value approach has improved quality and slowed the rising cost trend, there’s still much work to be done to ensure we can deliver high-quality care that’s affordable for all.

In support of the transition from the fee-for-service model to value-based care, we’ll be introducing a 1.5% allocation from Blue Cross commercial (PPO) professional fees to fund Blueprint risk arrangements for our Blue Cross commercial providers, starting July 1, 2023. These risk arrangements will be partially offset by our annual professional fee schedule update that will also take place starting July 1. 

The 1.5% allocation will be allotted to the Blueprint reward pool and used to reward eligible Risk Bearing Contracted Entities, or RBCEs, for improving the quality of patient care, transforming systems and practices, and reducing costs. Funding the commercial Blueprint incentives through the professional fee schedule is part of the mechanism we use to leverage customer dollars for provider-based incentive programs. 

Physician claim payment vouchers will reflect this change starting July 1, 2023. The vouchers will show the Blueprint allocation amount of 1.5% of the allowed amount, which is based on the Blue Cross commercial applicable fee schedule.

Here are some additional details:

• All funds from the Blueprint pool, including the allocation and any downside risk payments contributed back to the pool, are distributed to RBCEs that meet targeted commercial performance. 
• If the entire pool isn’t paid out in a calendar year due to variability in performance, the funds will be retained in the pool for distribution in the following year. If funds do carry over, the 1.5% Blueprint allocation may decrease to account for the retained funds in the Blueprint pool. 
• No funds in the Blueprint pool will be retained by Blue Cross for administrative costs.

A frequently asked questions document about the Blueprint allocation has been sent to physician organizations and RBCEs for their reference.