Blueprint for Affordability expands to include wide range of value-based initiatives

The high cost of health care continues to be a challenge for Blue Cross Blue Shield of Michigan’s customers and members. At the same time, patient expectations continue to rise. Our customers and members are searching for innovative solutions to improve the affordability and quality of care — and they’re looking to Blue Cross and its provider network for answers.

Blue Cross and its participating providers have been leading the move from traditional fee-for-service reimbursement to value-based care for nearly 20 years through our Value Partnerships initiatives. In December 2019, we launched Blueprint for Affordability, a bold next step in our efforts to improve affordability, starting with shared-risk contracts with health care providers.

With this model, providers agree to tie a portion of their reimbursement to their ability to successfully manage their patients’ health and health care costs. They share in the cost savings associated with effectively managing patient care, while paying back some of the costs if they fail to meet certain targets. In 2022, nearly 850,000 Michigan-based members were attributed to a provider participating in a shared-risk Blueprint relationship.

Since launching the shared-risk reimbursement model, we’ve expanded Blueprint for Affordability to include a broad range of value-based partnerships and programs that include an increased level of accountability, combined with support and rewards for providers involved in risk-sharing contracts. Many of these programs focus on seniors with multiple chronic conditions who typically have increased health care needs that can lead to high costs when those conditions aren’t well managed. We now consider Blueprint for Affordability to be an umbrella term to encompass all our shared- and full-risk provider partnerships.

“Blue Cross Blue Shield of Michigan is well-positioned to facilitate improvement in care delivery and payment models that encourage value-based care,” said Daniel J. Loepp, Blue Cross Blue Shield of Michigan president and CEO. “More than 20 provider partners are currently engaged in the shared-risk model — and more programs are coming soon. This strong foundation of collaboration with health care providers allows us to work together to efficiently implement new strategies with our current and future partners.”

You may have read about some of these initiatives in our provider publications previously, but here’s a brief overview of some of the newest Blueprint for Affordability components.

Full-risk models

• Contracts with network providers, starting with our Medicare Advantage plans. These contracts will be launching soon.
• Care for seniors in underserved areas of metro Detroit. Dedicated Senior Medical Centers, a subsidiary of ChenMed, and Oak Street Health are examples of these types of providers.
• In-home solutions to address the needs of our sickest members, including our partnership agreement with Landmark Health. Landmark provides high-intensity, in-home care for chronically ill members across Michigan.

Many new full-risk relationships are with physician organizations with whom we have longstanding relationships through our many years of work on value-based care. These POs are working with provider enablement companies to enhance the depth and effectiveness of their care as they take on increased accountability for well-managed care.

Condition-specific models

As background, we know that nearly 50% of the total cost of care is driven by the top 11 specialties. We also know that the quality and affordability of care within each of these specialties has a high degree of variability.

Many specialists continue to rely on fee-for-service contracting. Blue Cross wants to help these physicians transition more confidently into value-based care and clinically integrated networks that have proven care plans.

To better manage cost and encourage value-based care, we’re developing bundled payment programs for specific conditions. We’re also looking at programs that may assist members in identifying providers delivering the highest quality care at the most affordable cost.

Enablement solutions

We’ve joined forces with companies that can provide support to providers in shared- and full-risk contracts. Last year, we acquired TRIARQ Health, a management services organization that works primarily with specialists on their operations and business functions, helping them modernize their practices and succeed in value-based care models. We also entered into a joint venture with Honest Medical Group to offer physician organizations financial backing and support for Blueprint full-risk contracts.

“Health care is complex. Each of these partnerships and programs is part of a comprehensive strategy to address health care quality, cost and access, and improve member experience by working closely with providers in different ways,” said Todd Van Tol, Blue Cross executive vice president, Health Care Value.

An update: Our original Blueprint shared-risk program

Since we last wrote about Blueprint for Affordability in this newsletter last year, three additional health care provider organizations have signed shared-risk contracts:

• Spectrum Health (West Michigan)
• Integrated Health Partners (Southwest Michigan)
• Consortium of Independent Physicians Associations, or CIPA (statewide physician organization with significant rural presence)

The addition of these three organizations brings the total number of provider organizations (both physician organizations and hospital systems) participating in Blueprint shared-risk contracts to 22. This represents more than 50% of our in-state attributed membership for Blue Cross commercial and Medicare Plus Blue℠ (Blue Cross’ Medicare Advantage plan).

“We appreciate the willingness of these organizations to embrace change as we work to address the needs of our customers to reduce health care costs, while continuing to provide high-quality, value-based health care,” said Steve Anderson, vice president, Hospital Contracting and Network Administration.

As additional providers sign shared- and full-risk contracts — and as we continue to launch new programs to improve care quality and cost — we’ll keep you updated through this newsletter and The Record.

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