BCBS Michigan PGIP Value Partnership Translates
to Quality Improvement, Cost Savings

Blue Cross Blue Shield of Michigan's Physician Group Incentive Program (PGIP) is so studded with acronyms it's almost a separate language, jokes Donna Saxton, BCBSM's field team manager of BCBSM's value partnerships program.

And while not everyone speaks PGIP-tian, it's easy to translate the savings and benefits the medical home reward and incentives program portends for the insurer, its PCMH practices and its health plan members.

Ms. Saxton described PGIP's place in BCBSM's Value Partnerships program during Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures, including the structure of rewards and incentives that have produced results for the plan, which operates the largest network in Michigan.

Donna Saxton "PGIP incentivizes providers to enhance the delivery of care by encouraging them to be responsible and proactive in their behaviors, and ultimately driving better health outcomes and also increasing the fee for value that we also desperately need to get to," said Ms. Saxton.

In return, BCBSM provides financing tools and support for the nearly 18,500 primary care physicians and specialists who participateómore than half of BCBSM's physician population.

Aimed at some root causes of high cost healthcare, including a weak primary care foundation, PGIP, which Ms. Saxton described as the organization's "pinnacle" initiative, expects physician organizations (POs) to take responsibility for developing systems of care, motivating its physicians from within and adopting a culture of process improvement. In return, BCBSM places resources and a PGIP field team representative at the POs' disposal.

Some PGIP activities eligible for incentives range from e-prescribing and patient registries to specialist referrals and medical homes' linkage to community services, Ms. Saxton explained. Further, BCBSM has amped up three key medical home initiatives for its organized systems of care (OSC), "putting them on steroids," as Ms. Saxton said, to raise the performance bar and offer more chances for POs to earn incentives.

Compared to non-BCBSM-designated PCMHs, the organization's medical homes have produced some significant results, including an 11.2 percent decrease in primary-care related ED visits and a 6.7 percent reduction in low-tech radiology usage.

In case you missed this webinar, you still have a chance to watch this highly-rated program.

Register to view the conference today or order your training DVD or CD:
http://store.hin.com/product.asp?itemid=4847

You can "attend" this program right in your office and learn how the medical home reward and incentive structure fits into BCBSMís other value-based reimbursement programs; the partnership between Physician Organizations and how PCMH capabilities are implemented in physician practices; the outcome-based performance measures that have helped to improve quality and reduce costs that are associated with the PCMH designation program and how BCBSM consults with POs regarding improvement opportunities; how outcome-based performance measures have helped to improve quality and reduce costs; the role of specialists in this PCMH and their incentive structure and how to begin to engage this type of physician in process improvement principles; and the quality improvement and cost savings produced by this program.

Itís so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer ó any time of the day or night, whenever convenient for you and your colleagues ó and benefit from the archived recording of the conference, including the Q&A period.

You'll get to listen to the question and answer session to hear: examples of how regional differences can impact physician practices and their participation in physician performance-based reimbursement; the role of electronic health records and integrated patient registries in BCBSM's PCMH; how BCBSM educates members about the PCMH and the medical neighborhood; details on physician performance data sharing; and using an opportunity analysis report to educate physicians.

To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures, please visit:
http://store.hin.com/product.asp?itemid=4847

I hope you find it useful.

Cordially,

Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network

P.S. -- You may also be interested in these medical home resources: