Blue Cross Blue Shield of Michigan’s (BCBSM) Hospital Pay-for-Performance Program (P4P) rewards hospitals that excel at care quality, cost-efficiency, and population health management. Beginning in 2018, BCBSM allocated 10% of its P4P program budget to an episode of care spending metric based on MVC data. In designing and implementing the MVC Component of the BCBSM P4P Program, MVC endeavors to achieve fairness, measure validity, transparency, alignment with BCBSM and CMS quality measures, and a meaningful impact on quality improvement.
One Program Year (PY) of the MVC Component of the P4P Program occurs over multiple calendar years; in a given PY, MVC collects hospital claims data from a baseline year and performance year, begins assessment of this data after the performance year, and provides final scores for payment during a scoring year. In addition, the program follows two-year cycles, using the same structure and scoring methodology for all activities related to that cycle’s two PYs.
In calendar year 2023, hospitals will receive their final scorecards and payment for PY2022, their assessment for PY2023 will begin with mid-year scorecards expected in Q3, they will care for the patients comprising their performance year data for PY2024 and their baseline data for PY2026.
How do hospitals earn points toward the MVC Component of the BCBSM P4P Program? Learn the basic scoring structure for the Program Year 2022-2023 cycle.
Technical Document: PYs 2022-2023
Program overview of the structure, methodology, cohorts, and more for Program Years 2022-2023.
Cohorts for PYs 2022-2023
PY 2022-2023 cohort groupings for the main conditions (CHF, colectomy, COPD, joint replacement, pneumonia), CABG, and spine surgery.
PYs 2022-2023 FAQ
Frequently asked questions on the MVC Component of the BCBSM P4P Program for PYs 2022-2023.
Technical Document: PYs 2024-2025
Program overview of the structure, methodology, cohorts, and more for Program Years 2024-2025.
Program Changes for PYs 2024-2025
Learn what is staying the same and what is changing for Program Years 2024 and 2025 of the MVC Component of the BCBSM P4P Program.
PY 2024-2025 Explainer Webinar
Review the explainer webinar slides outlining the new program structure and scoring methodologies for Program Years 2024-2025.
View the webinar recording.
P4P Targets: Why MVC Doesn't Freeze
Learn the rationale behind MVC's decision not to freeze targets for P4P metrics, including a sample scoring scenario.