22 Jul 2026
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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.

12 Nov 2025
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MVC Announces Meeting Dates, Workgroups, and Trainings Available in 2026

MVC Announces Meeting Dates, Workgroups, and Trainings Available in 2026

November 12, 2025 | Comments Closed | , , , ,

As we head into the holiday season and final months of calendar year 2025, the MVC Coordinating Center has been planning for its 2026 engagement activities. At MVC's most recent fall collaborative-wide meeting in October, MVC first announced several key dates and updates related to next year’s engagement offerings. 

MVC’s 2026 event calendar is available now [PDF]. Of note, MVC site coordinators can see the dates for 2026 collaborative-wide meetings (Figure 1) and workgroups, as well as the months in which MVC will offer in-person or virtual networking events. MVC will head to Traverse City for its spring collaborative-wide meeting on May 8, 2026. MVC will return to Vistatech in Livonia for its fall collaborative-wide meeting on Oct. 9, 2026. 

Figure 1.

MVC 2026 collaborative-wide meeting dates & locations: May 8, Traverse City, Oct 9, Livonia

Also available is MVC’s Program Year (PY) 2026 P4P Engagement Point Menu [PDF]. Engagement activities offered in 2025 will largely continue along with some minor changes and new additions.

Earning P4P Engagement Points in 2026

In PY 2026 of the MVC Component of the BCBSM P4P Program, members can continue to earn up to two engagement points by completing eligible MVC activities. Many of the engagement point activities from PY 2025 remain available, such as attending or presenting at eligible MVC events, participating in site visits, utilizing MVC custom analytics, and survey submissions (Figure 2). Some of these offerings will have minor adjustments to their allotted point values. For example, attending a collaborative-wide meeting will now be worth 0.4 points compared to 0.25 points in 2025, and worth 1 point in 2026 for attending both meetings versus 0.75 in 2025.

Figure 2.

2026 engagement points menu options

Another minor change is the number of virtual workgroups offered. MVC will offer 18 virtual workgroups in 2026; these workgroups will continue to focus on similar topics and themes, including cardiac rehabilitation, preoperative testing, post-discharge follow-up, rural health, health in action, and sepsis.

New Engagement Offering

MVC is excited to introduce one new offering in 2026: site coordinator education modules. These modules will support site coordinators via one-on-one tailored training that covers a variety of topics (Figure 3). Site coordinators can receive 0.2 engagement points per module and may participate in as few as one module or all four within the performance year. Each quarter of 2026, MVC will offer limited registration to participate in a module. Registration to begin participating in 2026 Q1 will start in December 2025. Training topics provide a review of:

  1. Overview of MVC’s mission, history, P4P program, and site coordinator role
  2. Training on MVC claims data, metrics, and reports
  3. Introduction to MVC’s value-based initiatives and the CQI model
  4. Meeting with other site coordinators to collaborate and discuss practices

Figure 3.

Site coordinator education modules

As part of the online training, site coordinators will complete a structured education plan with individualized guidance to deepen understanding of how to get the most value out of MVC’s offerings.

Earn Engagement Points by Being a Presenter

For those sites participating in the MVC Component of the BCBSM P4P Program, being a presenter at an MVC event is an opportunity to earn 0.5 points toward your hospital’s PY26 engagement points. By sharing successes, lessons learned, and helpful tools with members from across the state, presenters play an important role in improving outcomes for all Michigan patients. MVC’s Engagement team is here to support you every step of the way, making the experience of presenting as easy and comfortable as possible. Presentation proposals are accepted on a rolling basis through MVC's online form.

MVC offers a variety of opportunities to engage with the Coordinating Centers and other members of the collaborative to support peer learning, best practice sharing, and networking. These activities and events foster a collaborative learning environment that enables providers to learn from one another in a cooperative, non-competitive space, and is therefore core to MVC’s efforts to support sustainable, high-value healthcare delivery across the state. We look forward to engaging with you and your teams next year. Please contact the Coordinating Center with any questions [EMAIL].

22 Oct 2025
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Hospitals Receive PY25 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY25 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

October 22, 2025 | Comments Closed | , , , , , ,

Last month the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This report provided hospitals with their current standing for PY 2025. It also included a preview of measure scoring for the new health outcome variation measure that will be worth one point in PYs 2026-2027.

Each hospital received a mid-year score out of a total of 10 points, including 0 to 4 points for their selected total episode payment metric, 0 to 4 points for their selected value metric, and 0 to 2 points for completed eligible engagement activities. PY 2025 scores achievement and improvement points for each hospital’s selected episode spending conditions and value metrics using index admissions from 2024 performance year data against admissions in 2022 as the baseline year. Hospitals are awarded the higher of their achievement and improvement point scores.

The performance data timeframes included in mid-year PY 2025 scoring were index events 1/1/2024 – 12/31/2024 for BCBSM PPO Commercial, BCBSM Medicare Advantage (MA), BCN HMO Commercial, BCN HMO MA, and index events from 1/1/2024 – 6/30/2024 for Medicare FFS. The engagement points accrued represent all completed activities from 1/1/2025 – 7/31/2025. All scores are subject to change in the final scorecards as the remaining 2024 performance data becomes available and additional 2025 P4P engagement activities are completed and recorded for this year.

Figure 1 illustrates the current distribution of total points out of 10 across the collaborative. The average points scored across the mid-year scorecards was 6.3 out of 10. This average is 0.3 points lower than the average points scored at the conclusion of PY 2024.

Figure 1.

dot graph

Figure 2 illustrates the breakdown of scoring on average by each program component (i.e., episode spending metric, value metric, engagement points). Hospitals could earn up to four points for their episode spending and value metric selections, and up to two points for engagement activities completed in 2025. Across the collaborative, the average points scored for both episode spending and value metrics was 2.6 points, and 1.2 points for engagement activities.

Figure 2.

vertical bar chart of average score across hospitals for episode spending metric, value metric, engagement points

Figure 3 illustrates the breakdown of the average points by episode spending conditions. Coronary Artery Bypass Grafting (CABG) was the highest scoring episode spending condition with an average of 3 points, and this was closely followed by joint replacement with 2.7 points. The lowest scoring episode spending condition was pneumonia with hospitals earning less than 2 points on average.

Figure 3.

vertical bar chart of average points by episode spending conditions

Figure 4 illustrates the breakdown of average points by value metrics. Consistent with PY 2024, the highest scoring value metric was preoperative testing with 3.9 points followed by 30-day inpatient readmissions after sepsis with 3.2 points. The lowest scoring value metric was 7-day follow up after pneumonia and follows the same trend as that of PY 2024 with 1.8 points.

Figure 4.

vertical bar chart of average points by value metrics

This is the second year of a two-year (PY 24-25) P4P cycle. The full methodology for this program cycle can be found in the PY2024-2025 technical document.

In addition to the PY 2025 mid-year scorecard summary, this report also included a preview of the new health outcome variation measure scoring, which will be worth one point in PY 2026-2027 (Figure 5). The table presents the hospital’s payer-specific risk-adjusted readmission rates in the performance year, the baseline and performance indexes for the hospital, and the target indexes required to score a point via improvement or achievement. This table’s scoring is based on PY 2025 data (i.e., 2024 performance year data and 2022 baseline data). Please note that this table was included to help orient members to the scoring methodology for this new measure and does not impact PY 2025 scores. For detailed information about this measure, please refer to this introductory video and PY 2026-2027 P4P technical document.

Figure 5.

Table presents the hospital’s payer-specific risk-adjusted of readmission rates in the performance year, the baseline and performance indexes for the hospital, and the target indexes required to score a point via improvement or achievement.

These PY 2025 P4P mid-year scores are subject to change as new data is added. The final scores will be distributed after all 2024 claims are incorporated into the calculations. Hospitals can track their score via the P4P PY 2024-2025 dashboard reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points. These registry reports can be filtered by selected conditions/metrics to make tracking of P4P points easier. You can also contact the MVC Coordinating Center [EMAIL] for a walkthrough of your hospital’s PY 2025 mid-year scorecard or P4P registry reports.

10 Sep 2025
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Push Report Details New MVC Measure that Quantifies Gaps in Patient Outcomes

Push Report Details New MVC Measure that Quantifies Gaps in Patient Outcomes

September 10, 2025 | Comments Closed | , , , , ,

MVC distributed a new push report on Aug. 28, highlighting the components and methods for MVC’s newest measure: health outcome variation for all-cause readmissions. The goals of the recently distributed push reports are to familiarize hospital members with the measure methodology as well as provide a first look at their hospital’s performance.

This measure was developed with the goal of addressing common challenges by MVC’s members in identifying and addressing gaps in health outcomes within their patient populations. A survey distributed to the MVC collaborative in 2024 identified barriers such as insufficient data and insufficient financial investments as key causes for lingering variation across their patient population. With the introduction of MVC’s health outcome variation measure, MVC seeks to quantify the magnitude of hospital-level variation in all-cause readmission rates between payer groups using an index of variation calculation. Readmission rates are risk adjusted for patient demographic and comorbidity data, as well as for non-medical drivers of health.

The first two pages of the push report provide a step-by-step walkthrough of the index calculation, beginning with the calculation of absolute differences in hospital-level readmission rates by payer group compared to the hospital-level average readmission rate. The five payer groups included in these calculations are BCBSM and BCN Commercial, BCBSM and BCN Medicare Advantage, Medicaid only, Medicare FFS only, and patients dual-eligible for Medicaid and Medicare; dual-eligible patients have been pulled out of the Medicaid only and Medicare only categories. This initial step helps to highlight which payer group(s) have a higher readmission rate than the hospital’s average rate (Figure 1).

Figure 1.

vertical bar chart of calculation of absolute differences in hospital-level 30-day readmission rates by payer group compared to the hospital-level average readmission rate

The next step in the methodology is to calculate a hospital’s index of variation using absolute differences in payer-specific risk-adjusted readmission rates compared to the hospital’s risk-adjusted average readmission rate. These payer-specific absolute differences are multiplied by the respective payer population proportion to yield weighted differences (Figure 2). The sum of those weighted differences across all five payer groups yields the hospital’s index of variation. This index calculation indicates the magnitude of payer-specific differences in risk-adjusted readmission rates within a hospital. A higher value indicates a larger spread in a hospital’s payer-specific risk-adjusted readmission rates as well as opportunities to develop strategies that reduce gaps in care across patient groups. A lower value is desired and indicates less variation in a hospital’s risk-adjusted readmission rates across payers.

Figure 2.

table: demonstration calculation a hospital’s index of variation using absolute differences in payer-specific risk-adjusted readmission rates compared to the hospital’s risk-adjusted average readmission rate

MVC first announced this measure at its fall 2024 collaborative-wide meeting, where Senior Advisor Jim Dupree, MD, MPH, announced its inclusion in the next cycle of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. Scoring on this measure will be offered in the Program Year (PY) 2025 scorecards with no points attached and thereafter will be worth one point in the PY 2026-2027 cycle.

Similar index or composite measures have been utilized by other health organizations, and MVC’s risk-adjusted measure can help identify hospital-level preventable differences in readmissions. Hospitals will earn the health outcome variation point by improving relative to their own baseline index or by performing well relative to their peers (i.e., having an index at or below the collaborative-wide median index).

As hospitals review their provided push report and become familiar with this new health outcome variation measure, they are encouraged to reach out to MVC with any questions.

04 Jun 2024
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MVC Finalizes Summary Evaluation of PY22-23 P4P Cycle

MVC Finalizes Summary Evaluation of PY22-23 P4P Cycle

June 4, 2024 | Comments Closed | , , , ,

This year, the Michigan Value Collaborative (MVC) completed all scoring and evaluation for Program Year 2023 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 2022 and 2023. MVC is excited to share its member evaluation document for these two program years, which highlights hospital performance on average 30-day risk-adjusted, price-standardized total episode payments for the included conditions across both program years.

The PY 2022-2023 program cycle utilized episode claims from 2019 through 2022. PY 2022 scoring compared performance year data from 2021 against baseline year data from 2019. PY 2023 scoring compared performance year data from 2022 against baseline year data from 2020.

Hospitals chose two conditions from seven available options for the PY 2022-2023 program cycle, including chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG), congestive heart failure (CHF), colectomy (non-cancer), joint replacement (hip and knee), spine surgery, and pneumonia. Among these seven P4P conditions, joint replacement was the most selected condition (40), and colectomy was selected the least (4). Trends in average price-standardized episode payments showed a consistent decrease over the years for CABG and joint replacement, and a recent downward trend for pneumonia, spine, and colectomy payments as seen in Figure 1. MVC observed relatively consistent average payments over time for CHF and COPD episodes during PY 2022-2023.

Figure 1. Average Price-Standardized Episode Payment Trends for P4P Conditions

The most striking observation in PYs 2022 and 2023 is the increasing shift to the outpatient setting for both spine and joint replacement surgeries. For joint replacement surgeries, 23.2% of episodes took place outpatient in 2019, 49.4% were outpatient in 2020, 71.6% were outpatient in 2021, and 85.4% were outpatient in 2022. Similar shifts were observed for spine surgeries during the PY 2022-2023 cycle, with the percent of outpatient spine surgery procedures increasing from 30.4% in 2019 to 51.4% in 2022 as seen in Figure 2.

Figure 2. Utilization of Outpatient Setting for Spine Surgery by Year

This shift in outpatient utilization also impacted the decrease in average total episode payments since the associated costs for outpatient surgeries were significantly lower than inpatient surgeries. The decrease in total episode payments for spine and joint replacement surgeries was largely reflected in the index payments for PYs 2022 and 2023 respectively (Figures 3 and 4).

Figure 3. Change in Average Price-Standardized Episode Components, PY 2022

Figure 4. Change in Average Price-Standardized Episode Components, PY 2023

Overall, there was not much change between PY 2022 and PY 2023 in the overall points earned and average points based on hospital characteristics, though the scores on average were slightly higher in PY 2022 (Figures 5 and 6).  For detailed, condition-specific analyses on scoring, please refer to the full member evaluation document.

Figure 5. PY 2022 Total Point Distribution (Includes Bonus Points)

Figure 6. PY 2023 Total Point Distribution (Includes Bonus Points)

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2022 and 2023 and the MVC P4P FAQ PY 2022-2023. If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

 

25 Feb 2021
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Opportunity to Share your Perspective in Institutional Participation in the MVC Component of the BCBSM P4P Program

February 25, 2021 | 0 Comments | , ,

MVC Senior Advisor and former Director, Dr. Scott Regenbogen recently received funding from The Donoghue Foundation to lead a team of investigators to learn more about institutional participation in the MVC Component of the BCBSM P4P Program.

As part of this study, Dr. Regenbogen is interested in conducting virtual interviews with lead administrators who were involved with selecting service lines for performance year 2017-2018

What is the value of participating? While participation in this study is completely voluntary and does not carry any bearing on P4P scoring, the insights gleaned from this work will help us to continue improving the MVC measure for the benefit of our members, and improve our understanding of successful strategies in commercial episode-based payment incentives.

What is The Donoghue Foundation? The Foundation supports a diverse portfolio of research projects, from understanding the mechanisms of disease, to improving clinical treatments, to public health initiatives that prevent illness – all founded on excellent science. To learn more about the organization and their mission, please visit https://donaghue.org/

Meet the Key Study Personnel

  • Scott Regenbogen, MD, MPH.  Dr. Regenbogen is an Associate Professor of Surgery and Chief of the Division of Colorectal Surgery at the University of Michigan (UM), and a Senior Advisor of the Michigan Value Collaborative (MVC). His research has focused on the role of perioperative care protocols in the costs, outcomes, and value of care around episodes of inpatient surgery, with a particular focus on older adults.
  • Shelytia Cocroft, PhD.  Dr. Cocroft is an applied medical sociologist and mixed-methodologist (qualitative and quantitative research designs).  She is currently a qualitative research analyst at the University of Michigan’s Center for Healthcare Outcomes and Policy (CHOP) and is collaborating on qualitative centric projects designed to identify systemic and structural mechanisms within surgical care that perpetuate inequalities in access, quality, and delivery of care.
  • Ashley Duby, MS.  Ms. Duby is the Research Director for the Division of Colorectal Surgery within the Department of Surgery and has been working with Dr. Regenbogen for the past 6 years. She has extensive experience in development and deployment of fieldwork protocols in diverse settings – including patient and provider populations.

If you have any questions or would like further information related to this project, please contact Ashley Duby, Research Director at agay@med.umich.edu.

11 Feb 2021
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MVC Component of the BCBSM P4P Program: PY20 in Review

MVC Component of the BCBSM P4P Program: PY20 in Review

February 11, 2021 | 0 Comments | , , , ,

In early January, the Michigan Value Collaborative (MVC) distributed 2020 Program Year (PY) scores to hospitals for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay for Performance (P4P) program. This marked the completion of the first year of a two-year cycle for which hospitals have selected two service lines (out of seven) to be scored on their episode spending using MVC data. These service lines include chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure 1 shows the frequency of hospital service line selections for the two-year program cycle.

Figure 1.

The program evaluates hospital’s risk-adjusted, price standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points in the program is by reducing their payments from the baseline period (index admissions in 2017) to the performance period (index admissions in 2019). These are termed ‘improvement points’. Alternatively, hospitals are able to earn points by being less expensive than the other hospitals in their cohort. These are referred to as ‘achievement points’. The MVC cohorts are groups of hospitals determined to be peers using bed size, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each service line. Hospitals are also eligible to earn a bonus point for each service line provided all hospitals in their respective cohort who selected the same condition reduce spending by five percent. A maximum of ten points can be awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for Program Year 2020.

Figure 2.

On average, hospitals earned six points, an increase of around one point from the 2019 program year average. Twenty-four hospitals received bonus points within the COPD, colectomy, joint replacement, and pneumonia service lines. Consistent with previous years, joint replacement had the average points, with pneumonia coming in a close second (see Figure 3).

Figure 3.

If you have any questions regarding the MVC Component of the BCBSM P4P program, please refer to the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021 . If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at MichiganValueCollaborative@gmail.com.