PCP Value Based Reimbursement (VBR)

PCP Value Based Reimbursement (VBR)
2019-2020 Patient Centered Medical Home (PCMH) Designations

The BCBSM Value-Based Reimbursement (VBR) program provides for fee schedule uplifts for PCMH, quality performance, cost, and provider delivered care management (PDCM), up to a total of 150% of the fee schedule.

  • PCMH
  • 15%
  • Quality
  • 5%-15%
  • Cost
  • 10%
  • PDCM
  • 5%
  • Advanced PDCM
  • 5%
  • _____
  • Total =
  • 150%
  • Key Achievements:
  • 89% of MPP’s participating primary care physicians are eligible for a VBR
  • 21% received a VBR for exceptional quality performance above 80th percentile. This is a 43% improvement over prior year.
  • MPP Physicians who performed above the 95th percentile for Quality are:
    • Lisa Higley, DO
    • Brian Mahany, DO
    • Mary Puls, DO
    • Michael Sullivan, DO
    • Edward Swisher, MD
  • BCBSM of Michigan has announced the 2019-2020 Patient Centered Medical Home designations. We are pleased to share that 90% of our primary care practices achieved designation. This is a two-percent improvement over the prior program year. Practices that achieve designation for at least three consecutive years earn an honor roll status. 57% of our patient centered medical homes achieved an honor roll status.

    If you have questions, please contact Deana Miracle, Manager of Quality via email at deana.miracle@mclaren.org or call 248-484-4932 for more information on the PCMH or VBR program.