VBR
BCBSM is continuing their Value Based Reimbursement (VBR) model to encourage and reward quality improvement this year. The measurement period is for 2025 with the payout period in 2026.
MSQC 2026 VBR Measures with detail
MSQC 2026 VBR Measures diagram
BCBSM Value Based Reimbursement presentation from 12/13/2024 MSQC Meeting (video recording available, login to MSQC Workstation for access)
The Value Partnerships program at Blue Cross develops and maintains quality programs to align practitioner reimbursement with quality of care standards, improve health outcomes and control health care costs. Practitioner reimbursement earned through these quality programs is called value-based reimbursement (VBR). The VBR Fee Schedule sets fees at greater than 100% of the Standard Fee Schedule. VBR opportunities include PGIP practitioners who participate in the Michigan Surgical Quality Collaborative (MSQC), and that meet specific eligibility criteria. The coordinating center clinical leadership, jointly with Blue Cross, set quality and performance metrics for its VBR. Each CQI uses unique measures and population-based scoring to receive Blue Cross VBR. CQI VBR is applied in addition to any other VBR the specialist may be eligible to receive. The CQI VBR applies only to reimbursement associated with commercial PPO BCBSM members. This is an annual incentive program.
2025 FTE Model
The MSQC FTE Model for 2025 (January 1, 2024 to December 31, 2024 cases) is 820 sampled and complete cases = 1.0 FTE (prorated up or down based on actual volume)
Blue Cross covers most of the costs for data abstraction, estimated to be approximately 84 percent of your hospital’s total participation costs. It’s important to know that these costs are carefully calculated based on a full-time equivalent model, therefore, one data abstractor shouldn’t do the work of several. To ensure success as a hospital, it’s important to allocate the necessary resources to CQI participation.