PGIP

Physician Group Incentive Program or PGIP is extensive. Considering your specialty, it may not seem to be as extensive for your practice as it would appear. However BCBS has slowly been increasing incentives for specialties over the last few years. To understand the entire program, I would start with the Blue Cross Website, or Google preferred partnerships BCBSM.

Is your practice in the PGIPS Defined List of Specialties? Please take our Survey to let us know.

PGIP has GROUP incentives marked by the "golden" color below. The incentives are what incorporate our specialist members to a point. Items in 'green' below are PCMH but important to the outcomes of our entire PO.

To understand how this works, NPO has 2 board members who are currently PCMH designated through PGIP Both physicians are our "champions" when it comes to sharing their experiences and outcomes with our membership. Nathan March DO of West Front Primary Care and Richard Nielsen, MD of Crystal Lake Clinic.

Group incentives are modified and added-to by BCBS with selection by the PO on a yearly basis. Notification of these additions/changes is communicated to the PO's sometimes only months before they are introduced. It is now NPO's job to stay up-dated and to keep our membership informed.

Current initiatives

Condition-focused:
  • Cardiac Care (new in 2011)
  • Chronic kidney disease
  • Encouraging evidence-based utilization of hysterectomy (new in 2011)
  • Encouraging evidence-based utilization of labor induction (new in 2011)
  • Improve Oncology Practice performance through participation in the American Society of Clinical Oncology. Quality Oncology Practice Initiative
  • Michigan Oncology clinical treatment pathways
Core Clinical process-focused initiative:
  • Coordination of care (PCMH)
  • Environmental Cancer (new in 2011)
  • Evidence-based care tracking to reduce gaps in care
  • Extended access (PCMH)
  • Individual care management (PCMH)
  • Lean for clinical redesign CQI
  • Linkage to community services (PCMH)
  • Patient Portal (PCMH)
  • Patient-provider partnership (PCMH)
  • Patient registry (PCMH)
  • Performance reporting (PCMH)
  • Preventive services (PCMH)
  • Self-management support (PCMH)
  • Specialist referral process (PCMH)
  • Test tracking and follow-up (PCMH)
  • Transitions of care
Service-Focused initiatives:
  • Emergency department utilization
  • Increase the use of generic drugs
  • Inpatient utilization
  • Michigan Anticoagulation Quality Improvement initiative - MAQ12
  • Radiology Management
Clinical Information technology-focused initiatives
  • Accelerating the adoption and the use of electronic prescribing

 

Other BCBSM Physician Group Incentive Program (PGIP) Options

There are five types of practices that can receive PCMH status: pediatrics, general practice, family practice, internal medicine pediatrics and internal medicine. However, BCBSM offers additional incentives for many physicians through PGIP. Currently, the incentives are available to primary care facilities and most specialists. Beginning in January 2012, the list will grow to include all specialists. Any eligible practice can receive incentives based on the capabilities that they meet in the following areas:

  • Environmental Cancer Initiative
  • Evidence Based Care Tracking Initiative
  • Emergency Department Utilization
  • Increasing the Use of Generic Drugs
  • Radiology Management Initiative
  • Electronic Prescribing Initiative

Finally, there are PGIP incentives that are for primary care facilities and certain specialists (please contact NPO for a list). The categories for these incentives are the same as the 12 Domains of Function listed above in the PCMH section. As practices implement these PCMH capabilities, they can receive incentives even if they are not PCMH certified.