August 8, 2023
Blue Cross Blue Shield Specialist Value Based Reimbursement Updates
Blue Cross Blue Shield is updating their Specialist VBR for roll out March 2025. However, the data collection for these changes starts July 1, 2023 through June 30, 2024. Specialist VBR currently uses three core metric sets (Global Quality Index, Cost of Care PMPM and Cost Difference), and when applicable specific metric sets for certain specialties. In 2025, in addition to the original three core metric sets, Global Utilization Index will be introduced to the program, and Global Quality Index will be simplified to strictly focus on HEDIS metrics. Please review the grid below, from BCBS, to see the changes to the program.
Global Quality Metrics:
Global Utilization Metrics:
Summary of Current and Future Specialist VBR Metrics (reminder, these changes are for the March 1, 2025 Specialist VBR. Measurement period is July 1, 2023-June 30, 2024.)
Questions? Please reach out to MPPQuality@McLaren.org