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MVC Finalizes Summary Evaluation of PY 24-25 P4P Cycle

MVC Finalizes Summary Evaluation of PY 24-25 P4P Cycle

July 22, 2026 | Comments Closed | , , ,

This year, the Michigan Value Collaborative (MVC) completed scoring and evaluation for Program Year (PY) 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This concluded a two-year program cycle encompassing the program methodologies and conditions utilized in PYs 2024 and 2025. MVC recently completed an evaluation of these two program years, which focused on hospital performance on average 30-day risk-adjusted, price-standardized total episode payments for the included conditions as well as utilization rates for the included value metrics across both program years.

The PY 2024-2025 program cycle utilized episode claims from 2021 through 2024. PY 2024 scoring compared performance year data from 2023 against baseline year data from 2021. PY 2025 scoring compared performance year data from 2024 against baseline year data from 2022.

Hospitals chose one episode spending condition from six available options for the PY 2024-2025 program cycle, including chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement (hip and knee), and pneumonia. Among these six P4P conditions, joint replacement was the most selected condition (31), and pneumonia was the least frequently selected (6). Colectomy was not selected by any hospital.

Trends in average price-standardized episode payments showed a consistent decrease over the years for joint replacement. Both COPD and CABG showed relatively consistent trend in payments and had the highest payments in 2022 as seen in Figure 1. Both PYs saw an average decrease in payments in both CABG and joint replacement. Joint replacement was the largest contributor to the cost savings in this cycle with a decrease of $3 million dollars in PY 2024 and $1.9 million dollars in PY 2025.

Figure 1. Average Price-Standardized Episode Payment Trends for P4P Conditions (2020-2024)

Line chart showing 30-day total episode payments from 2020 to 2024 for five conditions: CABG, Pneumonia, CHF, COPD, and Joint. CABG payments remain highest around $50,000 with slight fluctuations, while other conditions show gradual increases between $14,000 and $18,000.

MVC further assessed the components contributing to total episode spending, and determined all conditions except COPD showed a decrease in spending in at least one episode component (i.e., index payment, professional services, post-discharge care, readmissions) across both PYs (Figures 2-3). Joint replacement showed decreased spending across all components in PY 2025 and across all components except readmissions in PY 2024. Similarly, all conditions demonstrated a reduction in spending for at least one post-discharge component in both PYs. Home health spending decreased across all conditions while inpatient rehabilitation spending increased for most conditions in both PYs. Emergency department spending also decreased for most conditions across both PYs.

Figure 2. Change in Average Price-Standardized Episode Components, PY 2024

Bar chart comparing 30-day episode component payments across five P4P conditions: CABG, CHF, COPD, Joint Replacement, and Pneumonia. Each condition's total payment is broken down into four color-coded components—Index (dark blue), Professional (orange), Post-Discharge (bright blue), and Readmissions (gray)—highlighting negative payment for CABG and Joint Replacement and positive payments for other conditions.

Figure 3. Change in Average Price-Standardized Episode Components, PY 2025

Bar chart comparing 30-day episode component payments across five P4P conditions: CABG, CHF, COPD, Joint Replacement, and Pneumonia. Payment components include Index (dark blue), Professional (orange), Post-Discharge (bright blue), and Readmissions (gray), showing negative total payments for CABG and Joint Replacement, and highest positive payment for Pneumonia.

In addition to selecting an episode spending condition, hospitals also selected one of seven available value metrics for the PY 2024-2025 program cycle. This included 7-day follow-up after CHF, 7-day follow-up after pneumonia, 14-day follow-up after COPD, 30-day inpatient readmissions after sepsis, 90-day cardiac rehab after CABG, 90-day cardiac rehab after PCI, and preoperative testing before low-risk surgeries (i.e., inguinal hernia repair, cholecystectomy, and lumpectomy). The 7-day follow-up after CHF metric (23) was the most frequently selected value metric followed by 90-day cardiac rehab after PCI (17). In contrast, 90-day cardiac rehab after CABG and 30-day inpatient readmissions after sepsis were the least frequently selected (5) value metrics.

Among the high-value metrics, hospitals that selected 14-day follow-up after COPD and 90-day cardiac rehab after PCI increased their utilization rate by 1.4% and 3.1%, respectively, from 2021 to 2023 (Table 1). In PY 2025, the utilization of 90-day cardiac rehab after CABG increased by 3.6% in 2024 compared to 2022 (Table 2). Among the low-value metrics, sepsis readmission rates decreased by 0.5% in PY 2024 and 7.0% in PY 2025. Preoperative testing rates decreased by 5% from 2022 to 2024 in PY 2025.

Table 1. Average Utilization Changes for P4P Value Metrics in PY 2024

Table displaying P4P value metrics with average utilization percentages for 2021 and 2023, alongside utilization change rates. Metrics include follow-up rates after CHF, pneumonia, COPD, cardiac rehab after CABG and PCI, inpatient readmissions after sepsis, and preoperative testing, with notable increases in 14-day COPD follow-up (1.4%) and 90-day cardiac rehab after PCI (3.1%).

Table 2. Average Utilization Changes for P4P Value Metrics in PY 2025

Table comparing average utilization rates for various healthcare metrics in 2022 and 2024, highlighting percentage changes. Metrics include follow-up periods after conditions like CHF, pneumonia, COPD, cardiac rehab after CABG and PCI, inpatient readmissions after sepsis, and preoperative testing, with notable increases in 90-day cardiac rehab after CABG and decreases in inpatient readmissions and preoperative testing.

Overall, the average total points earned remained relatively stable between PY 2024 (6.6) and PY 2025 (6.7), as shown in Figure 4. Average episode spending points decreased from 2.4 to 2.2, while average value metric points increased from 2.4 to 2.6, and average engagement points increased from 1.7 to 1.8 from PY 24 to PY 25.

Figure 4. Average Points Earned by Scoring Components in PYs 2024-2025

Bar chart comparing scores for PY 24 and PY 25 across four categories: Episode Spending Points, Value Metrics, Engagement Points, and Final Score. PY 25 slightly outperforms PY 24 in Value Metrics, Engagement Points, and Final Score, with both years scoring similarly in Episode Spending Points.

The distribution of total points earned by participating hospitals in PY 2024 and PY 2025 are shown in Figures 5 and 6, respectively. Approximately 15% of hospitals scored the maximum score of 10 points in PY 2024 and this proportion decreased to 10% in PY 2025.

Figure 5. Distribution of Hospital Total Points Scored for PY 2024

Scatter plot showing PY24 final scores of MVC hospitals participating in PY24-25 program, with scores ranging from 0 to 10. Data points are marked in blue, with mean score 6.6 in orange and median score 6.1 in gray, highlighting most hospitals scoring at or above median and mean.

Figure 6. Distribution of Hospital Total Points Scored for PY 2025

Scatter plot showing final PY 25 scores for MVC hospitals participating in PY 24-25 program, with scores ranging from 2 to 10. Plot includes orange line for mean score (6.7), gray line for median score (6.0), and dark blue dots representing individual hospital scores, highlighting most hospitals scoring at or above median.

Additional details are contained in the full report. Please contact the Coordinating Center for more details on the report or for any questions regarding the PY 2024-2025 cycle.

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Written by Kushbu Narender Singh

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