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.
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 or medium-sized hospitals can earn up to an extra 5% toward their operating costs. Here’s some more information:
Small hospitals can show value to their community by meeting expectations for care access, quality and effectiveness. Here’s some more information:
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:
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:
The PGIP Allocation is used to fund the PGIP reward pool.
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 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:
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:
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