Blue Cross Blue Shield of Michigan Launches Michigan’s First Value-Based Health Plan
by Meghan O'Brien
| 4 min read
Blue Cross Blue Shield of Michigan is bringing to market Michigan’s first Organized Systems of Care-based health plan, Blue Cross® Physician Choice PPO. Blue Cross Physician Choice PPO builds upon more than a decade of investments Blue Cross has made in value-based care across Michigan and offers small and mid-sized businesses a product that lowers health care costs by delivering coordinated quality care through Blue Cross Organized System of Care (OSC) to members. “Blue Cross is at the forefront of health care innovation by providing our customers one of the nation’s largest OSC- and value-based health plans,” said Dr. David Share, senior vice president of Value Partnerships at Blue Cross Blue Shield of Michigan. “Physician Choice PPO helps deliver lower costs by ensuring better coordinated care. It provides employers with the opportunity to offer affordable PPO options to meet their employees’ health care needs.” Organized Systems of Care are communities of doctors and hospitals within the Blue Cross PPO network that collaborate to provide customized, coordinated patient care. The OSC model provides mutual accountability for performance and cost among primary care physicians and specialists. It helps to connect members to a designated primary care physician and a community of care, which improves quality and lower costs by managing population health. Blue Cross’ newest health plan provides access to 38 OSCs throughout Michigan, offering members the ability to choose from more than 4,300 primary care doctors, 11,630 specialists and 118 hospitals. The Physician Choice PPO plan divides OSCs into two levels to ensure quality of care and lower costs. By selecting primary care doctors and providers in Level One OSCs, members have lower copays and deductibles. Opting for doctors and providers outside the Level One OSCs provide high quality, coordinated care but at a higher cost to the member. “OSC’s help better connect our members to their health care providers,” Share continued. “They help provide customized, coordinated care that fits the needs of each patient. It’s a system where the stronger performance of the provider works to deliver greater value to the patient, and ultimately lower cost to those patients’ employers. That’s how we promote higher-quality, more affordable health care – by driving patient-centered, efficient care within larger groups of doctors and hospitals.” Blue Cross Physician Choice PPO offers comprehensive coverage and essential health benefits employers and members have come to expect from a Blue Cross PPO plan at a lower cost. It helps minimize health care costs for employers by promoting member access to very efficient, high-quality OSCs. It enables smaller employers the ability to offer broad-access PPO benefits previously out of budget. The plan’s cost savings are a result of encouraging members to engage in their health care, with options to choose primary care doctors, hospitals and other medical services within an OSC to save on their out-of-pocket costs. “More than 90 percent of Blue Cross members have employer-based health insurance,” said John Dunn, vice president for Middle and Small Group Business at Blue Cross Blue Shield of Michigan. “While we are known for broad access within our PPO, we’re taking the PPO to the next level with this product. We believe employers who have been seeking HMO options for affordability reasons are going to be pleasantly surprised with how affordable Physician Choice PPO is by comparison.” Physician Choice PPO is an output of work Blue Cross has led for over 10 years by creating more than 25 value-based programs, such as the nation's largest Patient-Centered Medical Home initiative, to improve the quality of care for its members and contain costs within the health care system. For more information on how BCBSM’s Value Partnerships programs are improving care and lowering costs, visit www.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 4.5 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.