Piggy bank, money with a stethoscope

Blue Cross(R) Physician Choice PPO Combines Quality with Efficiency to Yield Savings for Customers

After more than a decade of working hands-on with physicians and hospitals across Michigan to build a system of higher-quality, more efficient care delivery, Blue Cross Blue Shield of Michigan has created an insurance product that recognizes one simple truth about health care – when doctors and hospitals work to coordinate care across settings, it costs far less to deliver it.

We believe our customers and members should share in that value.

Blue Cross® Physician Choice PPO is a health insurance product that accomplishes many things that our customers want, and recognizes the work of doctors and hospitals in transforming care delivery in Michigan on a population basis.

The product provides broad access to care within Blue Cross®’ PPO.  Members can see any doctor or visit any hospital in the PPO – literally thousands of sites of care.  The plan lowers members’ costs by reducing their cost-sharing for access to certain providers that have proven to be very efficient in delivering high-quality, lower-cost care for their entire population of patients. It lowers employer costs by taking the benefits of care provided efficiently at lower cost, and delivering that value back to the customer.

The plan protects our members’ interests by measuring provider efficiency at the population level, across thousands of patients.  Risk adjustment on a population basis ensures that no single person can be discriminated against by their doctor because they are higher-cost – a grossly inaccurate assertion contained in a poorly-researched Heartland Institute opinion article attacking the plan.  By measuring at the population level, physicians who care for disproportionately more unhealthy patients are included within the larger population, so no individual physician is incentivized to drop patients.

Rather than the “narrow network of low-cost providers,” as the Heartland piece asserts, Blue Cross Physician Choice PPO provides access to more than 4,400 primary care physicians, 11,000 specialists, 106 hospitals and 36 Organized Systems of Care in Michigan.

Broad access used to be associated with higher costs, given that all providers of care were basically lumped into the same network regardless of their proven efficiency or effectiveness.  Now, with Blue Cross Physician Choice PPO, we are giving our members the broad access they want while also giving them lower costs for seeking care with higher-performing physicians and hospitals.

People value access to quality care.  Employers value efficiency.  Both value better outcomes and lower costs.  Blue Cross has combined these ingredients into a forward-thinking health insurance product that takes the concept of value – and accelerates it.

Photo credit: 401(K) 2012

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