February 4, 2025
BCBSM High Value Referral Program
MPP wants to make you aware of a new program rolled out by BCBSM (Blue Cross Blue Shield of Michigan) in January 2025. This High Value Referral (HVR) incentive is a multi-year program aimed at transforming specialist referral patterns.
BCBSM is offering financial incentives for Physician Organizations (PO’s) to develop and implement processes that enable PCPs to redirect referrals to higher-value specialty providers. MPP will be expected to work with PCPs and practice units to integrate specialist scores into existing referral practices. BCBSM is developing future incentives for PCP’s and high performing specialists.
BCBSM will be grouping specialists into 3 tiers based on an observed vs expected cost and efficiency compared to a national database of claims data. A specialist physician will be given a score up to 100 points based 75% on efficiency and 25% on quality. The goal of this program is to shift referrals from Tier 3 specialists to Tier 1 and Tier 2 specialists where it will not cause an undue burden on the patient.
Tier 1 = provider is performing above expected efficiency
Tier 2 = provider performing at expected efficiency
Tier 3 = provider performing below expected efficiency
MPP is expected to receive specialist level data from BCBSM mid-late February 2025. MPP will provide more information on this program as it becomes available from BCBSM.
For more information, please contact Dr. Michael Ziccardi, CMO at [email protected] or (248) 484-4923.