Changes to the PGIP allocation will support Organized Systems of Care efforts

Using the same approach that has created the largest Patient-Centered Medical Home program in the country, Blue Cross is focused on helping organized systems of care (or OSCs) build infrastructure and integrated care processes. The goal is that by doing this, these systems can offer more efficient, coordinated care to the population of patients they serve. From the beginning, the Physician Group Incentive Program’s long-term goal has been to encourage primary care doctors, specialists, hospitals and other providers to create high-functioning, comprehensive OSCs, and to support them in their efforts.

As we announced in the April 2018 issue of The Record, the PGIP allocation increased from 5 to 7 percent of the allowed amount in July 2018 to help fund the new PGIP OSC initiatives.

Blue Cross is now taking the next step in its journey by creating the 2019 PGIP Risk-Bearing OSC Program. Starting Jan. 1, 2019, the 7 percent PGIP allocation will be directed as follows:

• Blue Cross will direct 2 percent to fund the 2019 PGIP Risk-Bearing OSC program. This new program rewards OSCs for managing the benefit cost trend of their attributed Blue Cross PPO patient population and is the first step in our pathway to risk strategy.
• The remaining 5 percent will continue to reward eligible POs and OSCs for improving the quality of patient care, system and practice transformation, and reducing costs.

In addition, the PGIP allocation will apply to most professional procedure codes regardless of the billed provider charge effective Jan. 1, 2019.

Providers contractually agree in their participation agreements to allocate a portion of their reimbursement to the PGIP fund. All funds allocated are distributed to physician organizations and OSCs that participate in PGIP to support physician practice and system transformation. No money is retained by Blue Cross for administrative costs.

For more information about PGIP, go to bcbsm.com/provider/value_partnerships/pgip.

Note: Claims for Federal Employee Program^® members are excluded from the PGIP allocation.