Blue Cross Blue Shield of Michigan has added another seven physician organizations to its Blueprint for Affordability program, which can reward participants with higher revenue if they prove successful in managing patients' health and lower costs of care.
Since Blueprint began in December 2019, 21 health care organizations now have joined the risk-sharing model, representing about 38 percent of the Michigan Blues' total commercial PPO membership and 42 percent of its Medicare Advantage PPO membership.
Designed to cut costs and improve quality, Blueprint includes most of the state's major hospital systems and physician organizations, including the initial seven health care organizations: Ascension Health, Warren; Trinity Health, Livonia; Henry Ford Health System, Detroit; Michigan Medicine, Ann Arbor; United Physicians, Bingham Farms; the Physician Alliance, St. Clair Shores; and Oakland Southfield Physicians.
"Blueprint for Affordability provides tools and support to assist physician organizations in delivering seamless, coordinated, timely and affordable care," said the Michigan Blues' CEO Daniel Loepp, in a statement. "As these physician organizations join in, more people benefit from higher quality health care, which in turn makes costs more affordable."
The new seven physician organizations are Accountable Healthcare Advantage, Beaumont ACO, Medical Network One, Oakland Physician Network Services, all in Southeast Michigan; Primary Care Partners Inc., in collaboration with Covenant HealthCare Partners Inc., Professional Medical Corp., all in Mid-Michigan; and Answer Health in West Michigan.
As encouraged by the Affordable Care Act of 2010, private and government payers have been attempting to move providers away from higher-cost traditional fee-for-service reimbursement system that rewards providers for higher utilization of services.
Blueprint is believed to be the state's first comprehensive commercial "two-sided" shared risk program. Similar to Medicare's "accountable-care organization" and specialty physician two-sided risk models, providers share in the savings but are also responsible for some of the loss if spending is above agreed-upon benchmarks.
Experts believe two-sided risk arrangements will become the norm over the next decade. It works like this:
Under five-year contracts, provider systems could gain additional revenue in the if they lower costs and improve quality, the so-called upside risk arrangement. But the 21 participating health organizations could be forced under the downside risk arrangement to refund payments to Blue Cross if annual total expenses for the covered patients exceed agreed-upon targets.
Blueprint also is designed to be revenue neutral so additional payments don't exceed savings and wind up driving up premiums on insured companies and individuals.
Because of ever-rising costs and the need to improve quality and patient outcomes, government and private payers like Blue Cross have been moving from traditional fee-for-service payment to value-based care.
"Patients want and deserve high-quality care. Their employers want costs that are more predictable and manageable," Loepp said. "These participating physician organizations are willing to put a portion of their reimbursement on the line, as they work toward more predictable costs and improved health care quality and efficiency for their patients."
Over the past 15 years, Blue Cross and provider partners have been pioneering the shift to value-based care in Michigan. Blue Cross has more than 50 Value Partnerships initiatives, including one of the nation's largest patient-centered medical home programs.
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December 11, 2020 at 03:27AM
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Blue Cross adds more 7 health systems to risk-sharing plan - Crain's Detroit Business
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