Health care providers in Blueprint for Affordability shared-risk program improve performance

We first published this article in the January-February issue of Hospital and Physician Update but are reprinting it here in case you missed it.

Nearly three years after the launch of the Blueprint for Affordability shared-risk payment model, we’re seeing some impressive results. Physicians in Blueprint arrangements improved affordability by more than $70 million, increased overall health care quality and improved patient outcomes.

“These results are especially impressive considering that the COVID-19 crisis disrupted most of health care over the past three years,” said Todd Van Tol, Blue Cross Blue Shield of Michigan’s executive vice president for Health Care Value. “Also noteworthy is that these results include commercial and Medicare Advantage members in our PPO plans.”

Currently, more than 50% of our total attributed Blue Cross commercial and Medicare Advantage Michigan-based membership is covered by physicians who participate in the shared-risk payment model. A total of 22 physician organizations have signed onto the Blueprint shared-risk program, making it one of the largest payment models of its kind nationally.

More details

Here are some additional results:

• In both 2020 and 2021, Blueprint providers outperformed their non-Blueprint peers in key measures related to affordability and quality. This corresponds to $52 million in lower Blue Cross commercial spend and $21 million in lower Medicare Plus Blue℠ spend.
• More than 60% of participating physician organizations outperformed their affordability targets for Blue Cross commercial members and earned a share of the savings generated by the program.
• Providers in the shared-risk Blueprint contract perform better than plan average on various quality metrics, including rate of breast cancer and colorectal screenings, childhood immunizations and diabetic control measures.
• In 2021, for Blue Cross commercial members, using a quality composite score made up of 14 different quality metrics, providers participating in a shared-risk Blueprint contract outperformed other providers by nearly five percentage points.

Announcing providers participating in full-risk arrangements

Blue Cross recently announced that six physician organizations have opted to participate in full-risk arrangements for treating their Medicare Advantage patients. As we wrote in an article in the November-December issue of Hospital and Physician Update, some physician organizations participating in shared- or full-risk arrangements are working with companies that will help them be more successful in value-based care models by offering “enablement solutions.”

The following table provides a list of physician organizations that have announced they’re signing full-risk agreements for their Medicare Advantage patients (both Medicare Plus Blue℠ and BCN Advantage℠), along with the enablement company they’re working with and their geographic coverage area.

Note: Some organizations are in both shared-risk and full-risk arrangements with Blue Cross.

Background

With Blueprint for Affordability’s shared-risk model, introduced in 2019, health care organizations agreed to put a portion of their payments from Blue Cross “at risk,” based on their success in managing their patients’ health, thereby lowering their total cost of care.

We recently expanded Blueprint for Affordability to include a broader range of value-based initiatives that include an increased level of accountability, combined with support and rewards for providers involved in risk-sharing relationships. Many of these programs focus on seniors with multiple chronic conditions who typically have increased health care needs that can lead to high costs when those conditions aren’t well managed.

We now consider Blueprint for Affordability to be an umbrella term to encompass all our shared- and full-risk provider partnerships.

“Blue Cross and provider partners have actually been pioneering the shift to value-based care in Michigan since 2005,” Van Tol said. “Through our many Value Partnerships initiatives, including the nation’s leading Patient-Centered Medical Home program, Blue Cross has saved $2.2 billion in medical costs.”

To read more

See the article, “Blueprint for Affordability expands to include wide range of value-based initiatives,” in the November-December 2022 issue of Hospital and Physician Update.