Program Details

Name of Payment Reform Program
  BCN commercial utilization models
Organization Name
  Blue Care Network of Michigan
Program Contact Name
  Alison Pollard
Program Contact Title
  VP Provider Affairs
Program Contact Email
  Apollard@BCBSM.com
Program Contact Phone
  734-887-5417
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
  MI
Lines of business
  Self-insured commercial, Fully-insured commercial
Stage of implementation
  Full implementation (e.g. available to all intended/applicable providers and members)
Date of Implementation
  January 1, 2009
Payment reform model alignment
  Shared-risk (other than bundled payment) and/or gainsharing with quality
Base payment methodology
  Other
Other base payment methodology
  Can include all of the above.
Participating provider types
  Primary care physicians, Hospital inpatient, Other
Other types of providers
  MCG groups always include primary care physicians, but may also include specialists and hospitals.
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  Preventable Admissions, Serious Reportable Events (SREs) that are not HACs, Never Events
Performance measures used
  Achievement (relative to target or peers) of Clinical outcomes goals(e.g., readmission rate, mortality rate, A1c, cholesterol values under control), Utilization results
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  Use of tiered/high performance or narrow networks
Information transparency
  We report to our network providers (e.g. hospitals and physicians)
Evaluation and results for program
  Program evaluation by insurer