Blue Cross Blue Shield of Michigan: Value Partnership Initiatives
Thousands of Michigan physicians and hospital professionals have joined with Blue Cross Blue Shield of Michigan to improve the quality, value and efficiency of health care for more than 1 million Michigan residents through Value Partnerships initiatives.
Value Partnerships initiatives are groundbreaking joint programs among BCBSM, physicians and hospitals that foster collaboration to improve health care for Michigan residents. These improvement efforts rest on using sound clinical and scientific information, like evidence-based medicine, to identify best practices and quality improvements.
Value Partnerships initiatives are made up of the:
- Physician Group Incentive Program,
- Hospital P4P Program;
- and Collaborative Quality Initiatives.
Physician Group Incentive Program (PGIP)
PGIP connects physician organizations from across Michigan and encourages collaboration and information sharing through work on various PGIP initiatives. These PGIP initiatives aim to improve multiple aspects of the health care system for BCBSM members as well as all Michigan residents. Current initiatives are:
- Developing foundational capabilities for practice improvement, such as initiatives to develop data analytic capabilities or quality management staff
- Improving care for diseases or health conditions that present significant opportunities for standardizing treatment and improving health outcomes, such as oncology or diabetes
- Improving use in targeted service or procedure categories with wide variation in practice patterns, such as high tech radiology or emergency visits
- Enhancing core clinical processes and the associated clinical information technologies needed to support them, such as tracking of needed services, managing orders and prescriptions, managing referrals, and coordinating access and communications among members of a patient-centered medical home
Physician organizations are rewarded for their progress as they work on the specific initiative opportunities that they have selected for their organization. This PGIP structure enables physician organizations to be supported by an incentive program that can be tailored to meet the needs of the BCBSM members who look to these organizations for their care.
Current areas of focus include developing a sophisticated information infrastructure and using it to proactively manage chronic illness on a long-term basis. For example, physician organizations are rewarded for:
- Transforming clinical practice in a manner consistent with the patient-centered medical home model
- Implementing e-prescribing in physician offices
- Promoting generics and other quality, cost-effective prescribing
- Improving imaging services use rates
Hospital Pay-for-Performance (P4P) program
The Blue Cross Blue Shield of Michigan Hospital Pay-for-Performance Program rewards short-term acute care hospitals that demonstrate achievement in three major categories:
- Quality
- Efficiency
- Participation in Collaborative Quality Initiatives (see below)
Through this program, hospitals earn incentives that are based on a percentage of their inpatient and outpatient operating payments. Performance is measured and compared against the performance of other hospitals in Michigan as well as national benchmarks.
Measures and components of the program were determined with input from hospitals, and include various quality and efficiency measures as well as participation in the Collaborative Quality Initiatives.
Collaborative Quality Initiatives
The Collaborative Quality Initiatives are programs that focus on common, costly procedures or treatments. Consortia of providers work together using comparative performance reports generated from data on all procedures to identify processes of care which are associated with optimal outcomes. This knowledge guides system improvements aimed at optimizing care and maximizing outcomes. The current CQIs are:
- Michigan Bariatric Surgery Collaborative
- Michigan Surgical Quality Collaborative
- BCBSM Cardiovascular Consortium/ CQI
- Thoracic and Cardiac Surgery CQI
- Michigan Breast Oncology Quality Initiative
- Peripheral Vascular Intervention Quality Initiative
- Cardiac Imaging CQI
