Blue Cross Blue Shield of Michigan works closely health providers to make meaningful improvements to systems of care, resulting in better outcomes for patients and millions of dollars in savings.
Our collaborative relationships with providers are rooted in longstanding efforts including the Physician Group Incentive Program, Patient-Centered Medical Home and Collaborative Quality Initiatives. These programs built the foundation of our innovative payment models, in which providers are reimbursed based on the quality of care they deliver to patients and the impact on their health.
Historically, the health care system been focused on volume: the more patients a doctor sees, and more services provided, the higher the reimbursement from payers like Blue Cross. This does not encourage delivering the right care, at the right time – which is costly.
When patients receive the best results for their health conditions and the best possible experience, at a cost they can afford, we achieve value in health care. By focusing on value – not volume – in contracts with providers, Blue Cross has been working on incremental change in the health care system for the past two decades.
We took these efforts to the next level in 2019 by launching a new wave of contracts with seven leading health organizations – our “Blueprint for Affordability.” These provider organizations agreed to put a limited amount of their payments from us at risk – to be paid based on the quality of care and experience delivered to patients. This is called “risk-sharing.”
Blueprint for Affordability is now one of the nation’s largest value-based programs with 22 provider organizations participating in 2022. More than 50% of total in-state Blue Cross members receive health care services from a Blueprint-affiliated provider. The effort is making a difference:
- Providers in the Blueprint program were more successful in delivering high-quality health care at affordable costs to their patients when compared to their peers in 2020 and 2021.
- The program has resulted in $70 million lower healthcare spend.
In 2022, Blue Cross advanced “risk-sharing” into “full risk” models: six physician organizations signed on to full-risk reimbursement arrangements for PPO and HMO Medicare Advantage plans. In these contracts, payments are fully tied to how well physicians manage the overall health and outcomes of their patients.
Ensuring our members get the personalized care they need – in the right setting, at the right time and at the right cost – has also driven us to offer new solutions to expand access to care:
- We are helping Medicare members access high-quality, affordable, personalized health care through a joint venture with Honest Medical Group.
- We are assisting members who need integrated, in-home care.
- We are ensuring care for senior residents who live in underserved areas of Michigan.
In 2022, we were ready to help our provider partners with solutions and tools to enable them to focus more on patient care and less on administration. We helped reduce the administrative burden of health care providers to enable success in value-based arrangements like Blueprint.
Blue Cross also launched a new provider portal that offers additional tools and functions with a simple, fresh look and updated search features. Our new portal offers a multi-payer platform, with easy-to-use online tools. Providers can request information for patients who have coverage with several different health plans, including our own.