Value Partnerships

At Blue Cross, you're more than a provider; you're our collaborative partner. Through our Value Partnerships programs, we'll work together to make health care better for everyone.

Why our partnership matters

1.
It helps enhance the quality of care for all patient populations.
2.
By sharing best practices, we assist in improving patient outcomes.
3.
Collaboration helps make health care more cost effective.
4.
Your quality improvement gets recognized through meaningful incentive programs.

How it works

Value Partnerships is a unique, collaborative approach to improving health care and making it more cost effective.

By partnering with you and other providers and hospitals across Michigan, we share best practices to improve patient outcomes.

Hospital Pay-for-Performance

Blue Cross Blue Shield of Michigan has two hospital incentive-based programs. We call them pay-for-performance, or P4P. Both programs recognize hospitals that excel at care quality, cost-efficiency and population health management.

We split these programs up based on hospital size. Large- and medium-sized hospitals are referred to sometimes as peer groups 1-4. Small rural hospitals are sometimes called peer group 5.

Large and medium-sized hospitals

Large or medium-sized hospitals can earn up to an extra 5% toward their operating costs. Here’s some more information:

Small, rural hospitals

Small hospitals can show value to their community by meeting expectations for care access, quality and effectiveness. Here’s some more information:

Physician Group Incentive Program

The Physicians Group Incentive Program consists of more than 20,000 primary care and specialist physicians in Michigan involved in quality improvement efforts.

This program, which began in 2005, connects 40 physician organizations focused on improving the health care system in Michigan. This is accomplished through collaboration, sharing of best practices and data collection to increase the overall value of care while reducing costs. Participating organizations are evaluated and rewarded based on these outcomes:

  • System transformation
  • Quality
  • Performance enablement
  • Optimization

Incentive reward

Blue Cross Blue Shield of Michigan rewards PGIP physician organizations for system transformation and population-level management. These rewards are usually given twice a year. 

 An organization’s reward depends on:

  • Participation
  • Performance and improvement
  • Accomplishing goals with its PGIP physicians

How we fund the PGIP reward pool

The PGIP Allocation is used to fund the PGIP reward pool. 

  • It is a percentage of the applicable fee schedule on most professional paid claims. 
  • All Blue Cross Blue Shield of Michigan participating providers agree by contract to make an allocation from their reimbursement into the PGIP reward pool. 
  • It is also applied on non-participating provider eligible professional claims
  • PGIP Allocation percentage increases are approved by the Blue Cross Chief Medical Officer and may increase each year. Providers will be notified of increases through The Record. The current PGIP Allocation is 6 percent. 
  • Language on the provider voucher reflects the PGIP Allocation.

More information about PGIP

Ready to join?

Application for PGIP (PDF)

Value-Based Reimbursement

Blue Cross Blue Shield of Michigan has developed a Value-Based Reimbursement model to reward Primary Care Physicians and Specialists.  This innovative approach to provider reimbursement, shifts from the traditional fee-for-service model to a value-based care model.  

Primary Care Physician Value-Based Reimbursement

Primary care physicians who participate in PGIP can receive reimbursement in accordance with the Value-Based Reimbursement Fee Schedule, which sets reimbursement at greater than 100 percent of the standard fee schedule. Primary care physicians are eligible to be considered for value-based reimbursement based on competencies, activities and performance. Because patient-centered medical home designation is the foundation of PGIP’s care transformation approach, Value-Based Reimbursement is available to PCPs who achieve PCMH designation and all other forms are contingent on being PCMH designated. PCMH designated primary care physicians may also receive VBR for:

  • Demonstrated clinical quality
  • Cost performance
  • Provider-Delivered Care Management
  • Provider-Delivered Care Management outcomes
  • Medication Assisted Treatment for opioid use disorder
  • Collaborative care – use of a psychiatric consultant and behavioral health care manager

Specialist Value-Based Reimbursement

Specialists who participate in PGIP can receive reimbursement in accordance with the Value-Based Reimbursement Fee Schedule, which sets reimbursement at greater than 100 percent of the standard fee schedule.  All physician specialty types, as well as chiropractors, podiatrists and fully-licensed psychologists are eligible to be considered for specialist value-based reimbursement. Some of the available specialist VBR options include:

  • Population-based VBR (available to all specialty types)
  • Collaborative Quality Initiative VBR (available to specialists who participate in and meet the performance targets of their CQI – see valuepartnerships.com for more information on the CQIs)
  • Medication Assisted Treatment VBR
  • Specialist Team-Based Care VBR (available to select specialty types that have a care manager in their office and that receive mobile alerts when high-risk patients present in the emergency department)

Want to learn more?

Read more about the impact Value Partnerships has on health care.

Learn more