Pay-for-Performance Program

The MVC Component of the BCBSM Pay-for-Performance Program

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.

Program Overview

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.

Supplemental Resources

PY24 Engagement Point Menu & Dates

PY24 engagement point offerings and event dates. PY24 is scored out of 10 points, with up to 2 points awarded for completing activities in 2024 from the engagement point menu. There are no bonus points in PY24.

Technical Document: PYs 2024-2025

Program overview of the structure, methodology, cohorts, and more for Program Years 2024-2025.

Cohorts for PYs 2024-2025

MVC cohorts for PY 2024-2025 episode spending and value metric measures.

PYs 2024-2025 Value Metric Selections

Value metric selections by hospital for PYs 2024-2025.

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.

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.