Two doctors looking at results

Blue Cross Blue Shield of Michigan adds seven more health organizations to transformative Blueprint for Affordability payment model

DETROIT, Dec. 9, 2020 – Blue Cross Blue Shield of Michigan continues to expand its Blueprint for Affordability program with health care providers across the state, adding seven physician organizations to the transformative, risk-sharing payment model. In total, 21 organizations are participating, representing roughly 38% of BCBSM’s total Commercial PPO membership and 42% of the Medicare Advantage PPO membership.

Moving away from traditional “fee-for-service” reimbursement which has proven ineffective in improving patient outcomes and lowering costs, Blueprint for Affordability is a risk-sharing contract where health organizations agree to put a portion of their payments from BCBSM “at risk” based on their success in managing their patients’ health, thereby lowering their total cost of care.

The seven organizations now signing on to risk-sharing agreements with Blue Cross are:

Southeast Michigan

  • Accountable Healthcare Advantage
  • Beaumont ACO
  • Medical Network One
  • Oakland Physician Network Services

Mid-Michigan 

  • Primary Care Partners, Inc., in collaboration with Covenant HealthCare Partners, Inc.
  • Professional Medical Corporation

West Michigan

  • Answer Health

Over the last year of disruption due to the coronavirus pandemic, clinicians and health systems have stressed the importance of care coordination and virtual care to provide continuity and ongoing service to their patients. With shutdowns and social distancing, ongoing patient outreach and coordination of care is vital to keeping people healthy and safe even while care is being delivered remotely. This makes the Blueprint for Affordability program even more attractive to provider organizations.

“Blueprint for Affordability provides tools and support to assist physician organizations in delivering seamless, coordinated, timely and affordable care,” said Blue Cross Blue Shield of Michigan President and CEO Daniel J. Loepp. “As these physician organizations join in, more people benefit from higher quality health care, which in turn makes costs more affordable.”

The Blueprint for Affordability payment model is the next step in Blue Cross’ ongoing transition from traditional fee-for-service payment to value-based care. Under this approach, each health organization has annual cost-of-care targets and clinical quality benchmarks to meet. The targets are tailored to each organization’s unique patient population. If an organization optimizes patient health to keep its overall cost below target and meets its quality performance metrics, it will receive additional financial rewards from Blue Cross. If quality metrics are not met, driving costs above target, the organization will rebate Blue Cross, and ultimately its customers, a portion of the overage.

“Patients want and deserve high-quality care. Their employers want costs that are more predictable and manageable,” Loepp said. “These participating physician organizations are willing to put a portion of their reimbursement on the line, as they work toward more predictable costs and improved health care quality and efficiency for their patients.”

Blue Cross and provider partners have been pioneering the shift to value-based care in Michigan since 2005. Through more than 50 Value Partnerships initiatives, including the nation’s leading Patient-Centered Medical Home program, Blue Cross saved $2.2 billion in medical costs. This has translated to nine premium reductions for small group customers over the past five years and moderation of rates in the individual and Medicare Advantage markets.

For more information, visit BlueprintForAffordability.com.

Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross provides and administers health benefits to more than 4.7 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. The company has been committed to delivering affordable health care products through a broad variety of plans for businesses, individuals and seniors for 80 years. For more information, visit bcbsm.com and MiBluesPerspectives.com.