A message from Dr. Martha Walsh, senior medical director and associate chief medical officer
The PGIP evolution: Looking back, forging a path forward

For nearly 20 years, the Physician Group Incentive Program has been transforming care practices that support most Michigan residents. Currently, about 20,000 primary care physicians and specialists participate in PGIP’s provider-led clinical quality improvements and care transformation efforts.

Yet, PGIP’s capabilities go far beyond our ongoing efforts to improve the health care system. PGIP’s organizational structure has allowed us to quickly engage groups of providers statewide by using its platform to disseminate information quickly and broadly. This has proven especially useful in the past few years as we’ve had to cope with issues that affect health care delivery across a broad spectrum of the population, including:

• The COVID-19 pandemic
• The Flint water crisis
• Behavioral health care
• The opioid epidemic

Organizationally, PGIP has also served as the springboard for the move toward value-based care through the Blueprint for Affordability program. PGIP helps to provide the infrastructure necessary to be successful in value-based care arrangements.

As market dynamics shift, competitors expand their offerings, and customer and member needs intensify, we need to continue to raise the bar. This means we need to elevate our expectations and requirements, along with the incentives we offer physicians and physician organizations.

We’re working to ensure the continued success of the program by supporting stronger systems of care, resulting in better outcomes for our members and all Michigan residents. And we want health care providers to be well supported by their POs to deliver the cost and quality outcomes expected of them.

Physician organization requirements

One way we can do that is by ensuring that PGIP physician organizations meet their participation requirements. Here’s a review of the basic participation requirements:

• POs should have 75 or more TRUST panel physicians or Traditional participating physicians, 50 of whom must be practicing as primary care providers.
• POs must have contractual authority to represent their physicians for this program and coordinate and facilitate practice improvements and program administration on behalf of the physicians.
• POs must continue to comply with program standards.

We’ll also be updating and enhancing PO requirements to focus on a variety of factors that contribute to high performance. Here are a few highlights:

Growth and vitality — Keeping and growing the number of physician members and their attributed patients

Board composition and executive support — Garnering support at the executive levels from Michigan practicing physicians who are actively contributing to the PGIP Reward Pool

Technology and analytic infrastructure — Leveraging information technology and analytics to support physicians in population health management

PO engagement and performance — Actively participating in foundational PGIP programs and exhibiting solid performance in quality initiatives over time

Supporting practices in succeeding in value-based reimbursement — Working collaboratively with practices to help them earn value-based reimbursement

We’ve found that PO engagement and performance determine not only the success of their member practices but also factor into the overall outcomes of their attributed populations.

We’ll be communicating about upcoming changes and expectations in The Record newsletter. We’ll also be working with PGIP POs over the next year to help answer their questions and ensure their ability to meet our expectations.

The bottom line is that we want our primary care physicians and specialists to feel supported, and our members — your patients — to have the best possible health outcomes.

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