Fostering Quality Rather Than Quantity of Care—Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan (BCBSM) has transitioned from the traditional fee-for-service physician model and now pays physicians fees that are tiered based on the previous year’s performance measured at the population level. BCBSM created “Value Partnerships” to actively support implementation of a patient-centered, team-based care model that has access to care information from across the health care delivery spectrum.

BCBSM partnered with physician leaders in Michigan to design and implement the country’s largest and most successful patient-centered medical home (PCMH) program. This program is contributing to the revitalization of primary care within the state and producing substantial improvements in quality at a lower cost. The Value Partnership program works to strengthen the performance of specialists to work effectively with their primary care colleagues as PCMH “neighbors” following a framework developed by the American College of Physicians.

Together, the primary care physicians, specialists and hospitals are encouraged to act as “organized systems of care” to improve outcomes of care for the population served. Taken together, these programs are facilitating a transformation in health care delivery within Michigan that has already saved $1.2 billion at BCBSM and has become a national model.