Blue Cross Blue Shield of Michigan

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.

Value Partnerships: Statewide Insurance Plan Collaborating with Hospitals and Physicians to Improve the Cost, Quality, and Outcomes of Care

Blue Cross Blue Shield of Michigan: Blue Cross and Blue Shield of Michigan’s Value Partnerships is a decades long collection of programs among Blue Cross, hospitals and physicians across Michigan to improve the cost, quality and outcomes of care. This collaboration requires trust from all parties, based on aligned values and the shared purposes of increasing access to affordable, quality care and improving the health of communities. BCBSM provides resources, via provision of a platform for statewide provider collaboration coupled with clinically rich data, trusting hospitals and physicians to develop solutions, holding them accountable and rewarding them for results. Here, trust bred reciprocal trust, as BCBSM trusted the providers to come up with solutions and thereby enhanced the providers’ trust in BCBSM. How does this build trustworthiness? This action advances the reliability and safety of the health systems and communicates to the public that they care about their patients above all else.

How It Works

BCBSM has a longstanding commitment to be our members’ and customers’ trusted partner by providing affordable, innovative products that improve their care and health. BCBSM also has a commitment to our social mission by increasing access to affordable care; enhancing the quality of care patients receive; and improving the health of Michigan’s citizens and communities.

Value Partnerships is a collection of statewide programs among Blue Cross, physicians and hospitals that make health care work better for everyone. It is a unique collaborative model that enables robust data collection and fosters the sharing of best practices, so health professionals can improve patient outcomes.

Value Partnerships began in 2005 with a handful of programs focused on quality improvement in primary and surgical care. Today, we collaborate with approximately 20,000 physicians and more than 130 hospitals statewide in a collection of quality improvement and value-based programs, including our Physician Group Incentive Program (PGIP), Patient-Centered Medical Home (PCMH), and Collaborative Quality Initiatives (CQI). PGIP providers are located in 81 of Michigan’s 83 counties, with PCMH-designated practices in all Michigan counties that have primary care physicians.

Value Partnerships reaches beyond BCBSM’s 4.5 million Michigan members, affecting the care that is provided to all Michigan residents through an all-patient, all-payer focus. This is an important factor in ensuring that best practice care processes are reliably provided to all patients, all the time. This approach sets us apart, enabling us to have strong relationships with our provider partners.

Skills and Competencies

Value Partnerships relies on the following skills and competencies:

Partnerships with the provider community to deliver clinical programs and aligned provider payments focused on high quality, affordable care that improves the overall healthcare delivery experience.
Design and execution of programs that are customized and collaborative, rather than a one-size-fits-all approach.
A portfolio of interdependent programs that collectively drive outcomes and are focused on investments in transformation of care processes.
Recognize and reward organizations, not just individual providers, and reward improvement, not just highest performance, to create meaningful incentives for all participants.
Encourage collaboration among participants.

Origins

In an effort to address many of the current challenges facing our health care system, BCBSM launched Value Partnerships – a collection of statewide collaborations with physicians and hospitals that transform the delivery and improve the quality of patient care. We collaborate with providers through a number of initiatives including physician incentives available through our PGIP and PCMH physician models, as well as value-based contracting with hospitals. Value Partnerships is also home to our internationally recognized CQI program, where hospitals and physicians across the state come together to collect, share, and analyze data, then design and implement changes to improve patient care, decrease complications, and lower costs in the most common and costly areas of surgical and hospital care. Within weeks of the pandemic hitting Michigan, our CQIs began collecting clinically rich data on hospitalized COVID patients to address the pandemic and search for best practices on treating patients.

Our innovative approach to transforming healthcare is enhancing clinical quality, decreasing complications, managing costs, eliminating errors and improving health outcomes. We have worked hard to create and maintain a health care system in Michigan that preserves and strengthens relationships between physicians and patients, and that delivers affordable, accessible and optimal care.

Effectiveness

BCBSM’s Patient-Centered Medical Home program is the hallmark initiative around access to primary care. Our proprietary PCMH designation program, so trusted in the industry that other local and national payers recognize and reward providers who achieve this designation, is the largest in the country with over 4,600 designated providers in 1,696 practices.

In 2020, when compared with non-PCMH practices, PCMH practices had:

35.5% less adult ambulatory care sensitive inpatient stays
33% less adult primary care sensitive ER visits
35.5% less adult hospital readmissions
39% less pediatric primary care sensitive ER visits
29% less pediatric ER visits

CQI outcomes include:

32,870 knee and hip replacement surgery patients avoided blood transfusions
393 trauma surgery patients avoided a serious complication or death
778 bariatric surgery patients weren’t readmitted to the hospital after surgery
1,497 cardiac surgery patients didn’t experience prolonged ventilation and 8,391 patients avoided a transfusion.

Simply put, these programs engage the provider community in developing and implementing improvement programs. They also put clinically rich data into the hands of the providers to help them with real-time decision-making. The results: moderated health costs – saving nearly $2.2B over the last decade.

Scalability

Our PCMH program was modeled after the national Joint Principles of the Patient-Centered Medical Home. Michigan-designated practices are also designated as Total Care providers by the Blue Cross Association. Total Care gives employers access to similar value based care providers when they have employees in multiple states.

Our CQIs are internationally recognized for reducing complications and avoiding costs. Blue Cross of Michigan has worked with multiple Blue Cross plans across the country to replicate our programs. Many of the findings of the CQI programs have generated best practices that have been implemented nationally to address utilization and quality concerns.