DETROIT, December 12, 2023 – Blue Cross Blue Shield of Michigan’s value-based care partnership program is one of the largest and most impactful value-based initiatives in the nation, with one million members now receiving care from a physician who participates in its Blueprint for Affordability program.
The Blueprint for Affordability (Blueprint) program is a partnership model that aligns provider incentives, financial accountability, and enhanced data and analytics to drive better outcomes for members. Recent results indicate that Blueprint physicians have achieved $93 million in lower costs and higher HEDIS® and Medicare Star quality performance over a three-year period.
Since the program launched in 2020, 25 physician organizations have entered into Blueprint agreements for their Blue Cross Commercial PPO, Medicare Advantage PPO and Blue Care Network Medicare Advantage plans. Currently, 70% of Medicare Advantage members and 57% of commercial PPO primary care-engaged members in Michigan receive care from a Blueprint provider.
“The physicians who are in the exam rooms, on the frontline, doing the good work to deliver high quality patient care, are key to the Blueprint program’s success, and we are so thankful for their partnership as we work together to improve patient experience and outcomes,” said James Grant, M.D., senior vice president and chief medical officer at Blue Cross.
Physicians in Blueprint commit to improve quality, patient experience, and cost of care trend. Each physician organization has cost and quality goals customized to their patient populations. Physicians who achieve these targets receive greater incentives to reinvest in patient care and share in the savings generated.Those who do not are financially responsible for a portion of their losses.
“The breadth of Blueprint participation is extraordinary, with physicians located throughout 82% of the state. Like with our Value Partnerships programs that began in 2005, we’ve been able to work collaboratively with physician organizations to develop a value-based reimbursement program and partnership model that results in higher quality, lower cost, and better experiences for members,” said Todd Van Tol, executive vice president, Health Care Value at Blue Cross.
The Blueprint program continues to grow.Holland PHO is the latest physician organization to enter a full accountability agreement for its Blue Cross Medicare Advantage PPO and Blue Care Network Medicare Advantage members, becoming the eighth physician organization in Michigan to fully align payments to cost and quality performance. Holland PHO has participated in the Blueprint shared accountability arrangement since 2020. In addition to Holland PHO’s new participation, more physicians have signed on to participate in existing full-accountability contracts starting in 2024.
Blueprint accelerates the movement of reimbursement away from the traditional fee-for-service model, which rewards physicians based on volume, rather than patient outcomes.
Physicians in the Blueprint program consistently outperform non-Blueprint physicians in quality measures, including better performance in rates of breast cancer and colorectal screenings, blood pressure control and diabetic control measures.
“Blueprint for Affordability balances the financial responsibility for quality, patient experience, and healthy outcomes. The results have been outstanding,” said Van Tol.“Our rapid progress in advancing value-based care is a testament to the exemplary physician organizations statewide who continue to partner with Blue Cross on better quality, more affordable health care.”
Blue Cross and physician partners have been leading 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.
The Heathcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.
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.