BCBS Michigan kick-starts full-risk reimbursement arrangements with providers

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Blue Cross Blue Shield of Michigan and six physician organizations across the state are launching full-risk reimbursement arrangements for their Medicare Advantage PPO and Blue Care Network Medicare Advantage plans, the insurer announced this week.

With these agreements, along with existing full-risk contracts, about 30% of BCBSM’s total Medicare Advantage membership now receives services from physicians in full-risk reimbursement arrangements.

The full-risk arrangements are expected to accelerate BCBSM’s efforts to shift reimbursement away from the traditional fee-for-service model, which pays per unit of service and rewards providers based on volume, rather than effectiveness, of the services provided to patients.

In full-risk agreements, payment is tied to how well physicians manage the overall health and care outcomes of their patient populations. Physician organizations agree to take financial accountability for the quality, experience and total cost of their patients’ care, and they must meet key outcomes and cost goals. When physician organizations meet quality and cost goals, they receive higher reimbursement, and when they don’t, they’re financially responsible for the added expense, said BCBSM.

WHAT’S THE IMPACT

The six organizations now signing on to full risk-sharing agreements with Blue Cross include Huron Valley Practice Affiliates; Medical Network One; Oakland Physician Network Services; United Physicians; Great Lakes Physician Organization; and Answer Health.

Each of these organizations is working with an “enablement partner” that provides tools and support to assist physicians in delivering coordinated, affordable care, and to help physicians be successful in the new payment arrangements.

BCBSM launched Blueprint for Affordability in December 2019 with a group of seven healthcare organizations that signed onto risk-sharing agreements. In those inaugural risk-sharing agreements, organizations agreed to put a limited amount of their payment at risk, to be paid based on their performance against quality, experience and cost targets.

In three years, the number of participating physician organizations and health systems has grown to 22, representing more than 50% of total in-state Blue Cross members and making it one of the nation’s largest risk-sharing payment programs. 

Initial results from 2020 and 2021 show Blueprint providers outperformed their peers in key measures related to quality and cost. This corresponds to more than $70 million in lower healthcare spend. It also includes better performance in various quality metrics, including rates of breast cancer and colorectal screenings, childhood immunizations and diabetic control measures, BCBSM said.

THE LARGER TREND

Blue Cross and provider partners have been moving on the shift to value-based care in Michigan since 2005, through Value Partnerships initiatives that include the Patient-Centered Medical Home program.

In August, ahead of open enrollment, BCBSM teamed with Maven Clinic to launch a new family building and maternity support program. It includes a personalized digital care app to help guide members through family planning, including different paths to parenthood, pregnancy, postpartum and pediatrics.

BCBS said the program will help address gaps around maternity care and family health and improve clinical outcomes for parents and babies.

ON THE RECORD

“We owe it to our members and customers to think and work differently; to address the key drivers of healthcare costs and collaborate on solutions that promote more successful outcomes and more affordable health insurance costs,” said Todd Van Tol, executive vice president, Health Care Value at BCBSM. “Blueprint for Affordability is our approach to sharing financial risk, improving the patient experience and keeping costs more manageable.”
 

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