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.