DETROIT, Dec. 14, 2022 – Blue Cross Blue Shield of Michigan and six physician organizations across the state are launching full-risk reimbursement arrangements for their Medicare Advantage PPO and Blue Care Network Medicare Advantage plans. With these agreements, along with existing full-risk contracts, about 30% of BCBSM’s total Medicare Advantage membership receives services from physicians in full-risk reimbursement arrangements.
The full-risk arrangements accelerate BCBSM’s efforts to evolve reimbursement away from the traditional fee-for-service model, which pays per unit of service and rewards providers based on volume, rather than effectiveness, of the services provided to patients.In full-risk agreements, payment is tied to how well physicians manage the overall health and care outcomes of their patient populations. Physician organizations agree to take financial accountability for the quality, experience and total cost of their patients’ care, and they must meet key outcomes and cost goals. When physician organizations meet quality and cost goals, they receive higher reimbursement. When they do not, they are financially responsible for the added expense.
The six organizations now signing on to full risk-sharing agreements with Blue Cross are:
- Huron Valley Practice Affiliates
- Medical Network One
- Oakland Physician Network Services
- United Physicians
- Great Lakes Physician Organization
- Answer Health
Each of these organizations is working with an “enablement partner” that provides tools and support to assist physicians in delivering seamless, coordinated, timely and affordable care, and to help physicians be successful in these new payment arrangements.
“These newest agreements are robust and demonstrate our collective leadership in advancing value-based payment models that improve quality and safety, avoid redundancy, and contribute to an improved patient experience,” said Daniel J. Loepp, president and CEO of Blue Cross Blue Shield of Michigan. “Physician organizations are willing to enter these arrangements because they know it will enable us to achieve our mutual goal of better, more affordable health care.”
In December 2019, Blue Cross launched Blueprint for Affordability with a group of seven healthcare organizations that signed onto risk-sharing agreements. In those inaugural risk-sharing agreements, organizations agreed to put a limited amount of their payment at risk, to be paid based on their performance against quality, experience and cost targets.
In just three years, the number of participating physician organizations and health systems has grown to 22, representing more than 50% of total in-state Blue Cross members and making it one of the nation’s largest, most comprehensive risk-sharing payment programs. Initial results from 2020 and 2021 show Blueprint providers outperformed their peers in key measures related to quality and cost. This corresponds to more than $70 million in lower healthcare spend. It also includes better performance in various quality metrics, including rates of breast cancer and colorectal screenings, childhood immunizations and diabetic control measures.
“We owe it to our members and customers to think and work differently; to address the key drivers of health care costs and collaborate on solutions that promote more successful outcomes and more affordable health insurance costs. Blueprint for Affordability is our approach to sharing financial risk, improving the patient experience and keeping costs more manageable,” said Todd Van Tol, executive vice president, Health Care Value at Blue Cross Blue Shield of Michigan.
Blue Cross and provider partners have been advancing the shift to value-based care in Michigan since 2005, through Value Partnerships initiatives that include the nation’s leading Patient-Centered Medical Home program. 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.