Research Shows Blue Cross Blue Shield of Michigan Program Improves  Health Care Quality, Lowers Cost

Research Shows Blue Cross Blue Shield of Michigan Program Improves Health Care Quality, Lowers Cost

A new study published in the April issue of Health Affairs shows Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (PGIP) is associated with higher quality of care and lower total spending for both adult and pediatric patients.  The study points to the progress made in shifting to a model that aligns payment with quality and outcomes.

The independent analysis, conducted through the University of Michigan Department of Health Management and Policy, reviewed quality and spending from 2008 through 2011 for more than three million beneficiaries from more than 11,000 practices. The analysis found that practice participation in PGIP is associated with a 1.1 percent lower total spending for adult patients, 5.1 percent lower total spending for pediatric patients, and higher performance on 11 key quality measures.  The study was fully funded by The Commonwealth Fund.

“The analysis specifically looked at the PGIP model, which is a partnership model that catalyzes physicians and physician organizations to transform systems of care within and across practices and uses a value based payment approach to reward them for efficient and effective care,” said David Share, M.D., MPH, BCBSM senior vice president for Value Partnerships. “Together, we’ve created a successful program that is strengthening primary care and population management in the state.”

Compared to nonparticipating practices, PGIP participating practices were found to have higher performance on quality measures for preventive care such as adolescent and child well care and adolescent immunizations.  PGIP practices also had higher performance in diabetes care, and breast and cervical cancer screenings.

“This analysis points to the potential of value-based reimbursement models to improve quality of care while reducing cost,” says Christy Harris Lemak, lead author and researcher, and currently chair of the Department of Health Services Administration at the University of Alabama at Birmingham. “The scope and structure of the PGIP program may offer a model for ongoing discussions on payment policy.

BCBSM’s Physician Group Incentive Program began 10 years ago as a way to improve the quality, safety and efficiency of the health care system in Michigan.  The program now has more than 19,000 primary care and specialist physicians participating in 81 of Michigan’s 83 counties.

The Physician Group Incentive Program is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, visit valuepartnerships.com.

Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association. BCBSM provides and administers health benefits to more than 4.4 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. For more company information, visit bcbsm.com and MiBluesPerspectives.com.

Photo Credit: Maryland GovPics

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