Managed Care Incentive Programs
PMC has contracts with more than 10 health plans that provide generous incentives aimed at improving the quality, efficiency, and overall value of health care. The purpose of these programs is to encourage providers to carry out improvements and to achieve optimal outcomes for patients. For more information on these programs, please contact your designated Practice Consultant.
Blue Cross Blue Shield of Michigan (BCBSM)
Physician Group Incentive Program (PGIP)
The BCBSM Physician Group Incentive Program (PGIP) supports and facilitates practice transformation using a wide variety of initiatives to reward physician organizations for improved performance in health care delivery. Through PGIP, BCBSM is helping to improve the quality of care so it is provided reliably to all patients, all of the time.
Patient-Centered Medical Home Initiatives (PCMH)
Patient-Centered Medical Home (PCMH) is a health care model led by a primary care physician that focuses on the health needs of each patient, coordinates patient care across all settings, and provides enhanced access to care.
Patient-Centered Medical Home – Neighbor Program (PCMH-N)
The Patient-Centered Medical Home – Neighbor Program (PCMH-N) works collaboratively with the PCMH care model, and encourages specialists to adopt practices and capabilities in line with the PCMH. A PCMH-N practice engages in processes that ensure effective coordination and integration with PCMH practices, ensures efficient flow of information, and supports the enhanced access to patient-centered, high-quality care.
Other PGIP Opportunities for Specialists
Blueprint for Affordability
The Blueprint for Affordability program, a value-based shared-risk contract through BCBSM emphasizes the importance of population health management to overall lower cost of care, increase quality performance, and increase patient satisfaction. Including the BCBSM commercial and Medicare Advantage lines of business, the Blueprint for Affordability model helps physician organizations maintain predictable expenses for patients and physicians.
Blueprint for Affordability Overview
Provider Delivered Care Management (PDCM)
BCBSM has partnered with the Michigan Institute for Care Management and Transformation (MiCMT) to support a statewide strategy to engage patients with chronic conditions through patient care teams. Supportive care teams include nurses, social workers, dietitians, pharmacists, community health workers, and other care team members who assist both primary care and specialist offices with services that support and promote the physician’s care plan and desired patient outcomes.
Centers for Medicare & Medicaid Services (CMS)
Comprehensive Primary Care Plus (CPC+)
Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ payment redesign gives practices the additional financial resources and flexibility they need to make investments that will improve quality of care and reduce the number of unnecessary services their patients receive.
Health Information Exchange (HIE)
Health Information Exchange (HIE) allows for health- and medical care-related information to be shared and accessed among healthcare providers. Sharing this information allows providers to exchange vital medical records regardless of where the patient is receiving care, whether local or distant hospitals and emergency rooms, specialists, radiology centers, or lab centers. Information can then be easily translated to notify care team members, including physicians and care managers, about the patient’s health.