Blue Cross Blue Shield of Michigan announced it joined up with seven providers in the state to launch Blueprint for Affordability, a new value-based care program that includes both upside and downside financial risk.
Ascension Michigan, Henry Ford Health System, Michigan Medicine, Oakland Southfield Physicians, the Physician Alliance, Trinity Health – Michigan and United Physicians signed on to the model, which kicks off Jan. 1. It will last for five years.
Executives at the health plan said on a call with reporters Wednesday that the risk-sharing approach will encompass about 30% of its membership in commercial PPO and Medicare Advantage PPO plans largely in the southwest part of the state, representing about $4 billion in healthcare spend.
“What I think makes this program particularly significant, impactful and unique is the scale at which we are rolling it out,” Todd Van Tol, senior vice president of healthcare value at Blue Cross, said on the call. “We believe this is the largest value-based payment reform of its kind in any state in the nation.”
The providers who signed on to the model agreed to work toward annual targets for the cost of care they offer Blue Cross members. Those that come in under these targets will earn financial rewards, while those who exceed them will be asked to reimburse Blue Cross a portion of the excess spending.
Blueprint for Affordability builds on prior work spearheaded by Blue Cross in Michigan to control costs. The insurer said that its 50 existing value-based partnerships have saved $2.2 billion since 2015, leading it to lower premiums nine times in the past four years for small group customers and stabilizing rates in the individual markets and for Medicare Advantage.
Blue Cross said the shared accountability ensures incentives are aligned to promote better quality care at a lower cost, and the provider partners echoed that sentiment, saying on the call that it put them back in the driver’s seat in managing care.
“We know quality improvements like this work,” said Paul Castillo, chief financial officer at Michigan Medicine, on the call.
Blue Cross will bring its data capabilities to the partnership, which it says will allow providers to be more proactive in caring for patients. For example, instead of waiting for a patient to come in with the flu, a physician will have access to data that flags whether he or she had the flu last season that led to an inpatient stay—indicating it’s time to bring the patient in for a visit.
Over time, Blueprint for Affordability should improve the patient experience, boost care quality, reduce unneeded care and services and better coordinate care across the continuum, Blue Cross said.
"This program really builds on our experience as a plan,” Van Tol said.