A message from Vicki Boyle, director of PGIP and PRP
Our pediatric measures: Supporting care quality while providing ample incentive opportunities

All health plans are required to report certain accreditation measures to the National Committee for Quality Assurance, or NCQA, each year — and this includes our pediatric measures.

We report performance on approximately 16 pediatric measures. These include such clinical quality measures as:

• Weight assessment and counseling for children and adolescents
• Appropriate testing for pharyngitis
• Appropriate treatment for upper respiratory infection
• Avoidance of antibiotic treatment for acute bronchitis
• Follow-up care for children prescribed medication for attention deficit hyperactivity disorder
• Follow-up care for hospitalization for mental illness
• Follow-up after high-intensity care for substance use disorder
• Childhood immunization status

Although there are fewer pediatric measures than adult measures, our Physician Group Incentive Program and Physician Recognition Program have been designed so that pediatricians have ample opportunity to earn incentive payments for high performance and improvement. And, for PGIP physicians who also have Patient-Centered Medical Home designation and who also offer Provider-Delivered Care Management, even greater reimbursement opportunities exist.

For example, PDCM practices that show a 10% improvement in the measure that assesses emergency department encounters can receive value-based reimbursement of $0.40 per attributed member per month during the measurement year.

We also recently launched a Pediatric Weight Management Initiative that includes a value-based reimbursement opportunity for PDCM pediatric practices. It was developed to address the alarming increase in childhood obesity for children ages 2 through 19. It rose from 18.3% in 2019 to 22.4% in 2020. We’ll bring you more details about this opportunity in the May-June issue of this newsletter.

At Blue Cross Blue Shield of Michigan, we’re proud to be able to offer pediatricians additional reimbursement for providing quality care to their young patients. And we’re prouder still of the great work pediatricians have done over the past two years to adhere to these challenging measures duirng the COVID-19 pandemic. For example, to help meet the childhood immunization status measure, many pediatric practices offered drive-through immunization clinics — a creative initiative that the NCQA also applauded.

For more information
To learn more about PGIP (including how to join) and our Value-Based Reimbursement Program, see the Value Partnerships section of bcbsm.com and scroll down to Physician Group Incentive Program and Value-Based Reimbursement.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.