Blueprint for Affordability program reaches 1 million members, solidifying national leadership

Blue Cross Blue Shield of Michigan’s value-based care partnership program is one of the largest value-based initiatives in the nation, with 1 million members now receiving care from a physician who participates in its Blueprint for Affordability program.

Blueprint is a partnership model that aligns provider incentives, financial accountability and enhanced data and analytics to drive better outcomes for members. Recent results indicate that Blueprint physicians have achieved $93 million in lower costs and higher HEDIS^® and Medicare Star quality performance over a three-year period.

Since the program launched in 2020, 25 physician organizations have entered into Blueprint agreements for their Blue Cross commercial PPO, Medicare Plus Blue℠ PPO and BCN Advantage℠ HMO plans. Currently, 70% of Medicare Advantage members and 57% of commercial PPO primary care-engaged members in Michigan receive care from a Blueprint provider.

“The physicians who are in the exam rooms, on the frontline, doing the good work to deliver high-quality patient care, are key to the Blueprint program’s success, and we are so thankful for their partnership as we work together to improve patient experience and outcomes,” said James Grant, M.D., senior vice president and chief medical officer at Blue Cross.

Physicians in Blueprint commit to improving quality, patient experience and the cost of care trend. Each physician organization has cost and quality goals customized to their patient populations. Physicians who achieve these targets receive greater incentives to reinvest in patient care and share in the savings generated. Those who don’t are financially responsible for a portion of their losses.

“The breadth of Blueprint participation is extraordinary, with physicians located throughout 82% of the state. Like with our Value Partnerships programs that began in 2005, we’ve been able to work collaboratively with physician organizations to develop a value-based reimbursement program and partnership model that results in higher quality, lower cost and better experiences for members,” said Todd Van Tol, executive vice president, Health Care Value at Blue Cross.

Continuing growth trend

The Blueprint program continues to grow. Holland PHO is the latest physician organization to enter a full accountability agreement for its Medicare Plus Blue PPO and BCN Advantage HMO members, becoming the eighth physician organization in Michigan to fully align payments to cost and quality performance. Holland PHO has participated in the Blueprint shared accountability arrangement since 2020.

In addition to Holland PHO’s participation, additional physicians have signed on to participate in existing full-accountability contracts, starting in 2024.

As you’ve read before, Blueprint accelerates the movement of reimbursement away from the traditional fee-for-service model, which rewards physicians based on volume, rather than patient outcomes. And the results have been good. Physicians in the Blueprint program consistently outperform non-Blueprint physicians in quality measures, including better performance in rates of breast cancer and colorectal cancer screenings, blood pressure control and diabetic control measures.

“Blueprint for Affordability balances the financial responsibility for quality, patient experience and healthy outcomes. The results have been outstanding,” Van Tol said.  “Our rapid progress in advancing value-based care is a testament to the exemplary physician organizations statewide that continue to partner with Blue Cross on better quality, more affordable health care.”

Blue Cross and physician partners have been leading the shift to value-based care in Michigan since 2005 through Value Partnerships initiatives that include the nation’s leading Patient-Centered Medical Home program. For more information, visit BlueprintForAffordability.com.

To read more about value-based care, see this article, also in this issue.

HEDIS^®, which stands for Heathcare Effectiveness Data and Information Set, is a registered trademark of NCQA.

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