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Health Care Effectiveness and Efficiency in Service of Community Wellbeing: The Physician Group Incentive Program (PGIP) and Organized Systems of Care (OSCs). David Share, MD, MPH Executive Medical Director, Health Care Quality Blue Cross Blue Shield of Michigan email@example.com. Outline.
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Health Care Effectiveness andEfficiency in Service of Community Wellbeing: The Physician Group Incentive Program (PGIP) and Organized Systems of Care (OSCs)
David Share, MD, MPH
Executive Medical Director,
Health Care Quality
Blue Cross Blue Shield of Michigan
Health care is local: natural communities of caregivers taking responsibility for creating systems serving community need
Practice Units that achieve PCMH Designation may continue to participate in PCMH Initiatives and are expected to demonstrate ongoing progress towards fully implementing PCMH domains of function
Table 1: Performance Statistics* for 2010 PCMH Designated Practices Compared to PGIP Primary Care non-Designated Practices -Adults
*Adjusted for age, gender, and risk score. Statistics based on members attributed to Primary Care Practitioners. 2010 claims data is preliminary and expected to change due to run-out.
General Principles, continued:
PGIP: Catalyzing Health System Transformation in Partnership with Providers
2004 2005 2006 2007 2008 2009 2010 2011 2012
Chronic Care Model
Primary care transformation
Organized Systems of Care
Continue to add new specialties to PGIP
Expand PGIP to include specialists involved in chronic care
Implement PCMH and quality/use initiatives
Continue to increase number of initiatives
Extend provider-delivered care management with links to BCBSM for customer reporting statewide
- Payers or Multi-stakeholder health care coalitions should support regional, collaborative efforts aimed at learning, implementing and disseminating knowledge about “what works” in system transformation
- Reimbursement should reward results at a population level (wholesale, not retail), freeing providers to lead practice transformation, and enhance care management, at the local and regional level