Nurse smiling at a patient lying in bed

Ensuring Equity in Blueprint for Affordability Contracts

Doctors live by the mantra “first, do no harm.”

It’s only fitting that the new Blueprint for Affordability contracts take the same approach between Blue Cross Blue Shield of Michigan and physician organizations and health systems across the state.

Under Blueprint, health care providers are rewarded with a bonus when they can keep their costs under a set target and when certain clinical quality metrics are met. But if the costs come in above target and the health care quality metrics aren’t met, the organization will owe money to Blue Cross , and ultimately to their customers.

That doesn’t mean doctors who see sicker patients will be penalized.

Equity has been built into each of the contracts, to ensure no harm is brought to the physician organizations and health systems that treat populations that are less healthy, or that may be at higher risks for chronic conditions, for example.

Thanks to data Blue Cross collects and analyzes, Blueprint contracts are tailored to each physician organization and hospital to account for their unique patient population.

Each year a total cost of care target is set for each physician organization and health system that signs on to Blueprint. Targets are set according to several measures, including the statewide average total cost of care. Those targets are adjusted if an organization sees more patients with chronic conditions, for example, and according to the mix of insurance plans their patients carry.

At the end of each benefit year, Blue Cross will analyze how well a physician organization did at meeting that cost of care target and at managing the health of their patients compared to statewide averages.

Healthcare Effectiveness Data and Information Set measures will be used to determine how effective an organization was at improving the quality of the health care they provided, based on a minimum quality threshold that is based on their historical performance. HEDIS measures are longstanding nationally accepted measures of clinical quality.

By setting the bar for quality and cost, Blueprint for Affordability contracts promise to improve the experience for patients. Patients with doctors in Blueprint organizations will see more proactive care management from providers, and more communication between hospitals and health systems and primary care doctors.

Learn more about Blueprint for Affordability at www.blueprintforaffordability.com.

Related stories:

Photo credit: Paola Giannoni

Leave a Comment

Your email address will not be published. Required fields are marked *