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BCBSM Incentive Programs

Here you can find resources about the Blue Cross Blue Shield of Michigan Pay-for-Performance (P4P) and Value-Based Reimbursement Programs, specific to HMS requirements and incentives.

Pay-for-Performance Program (P4P)

HMS is one of the Collaborative Quality Initiatives (CQI) sponsored by the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships Program. One of the ways hospitals are incentivized for high quality care is through the Pay-for-Performance (P4P) program. This program is an incentive-based initiative designed to reward short-term acute care hospitals for achievements and improvements in quality of care and population health management. Hospitals earn P4P scores based on specific performance measures developed by each CQIs Coordinating Center. These measures include both participation metrics—such as meeting attendance and timely data submission—and outcome-based metrics—such as reductions in complications or improvements in clinical processes. Each hospital’s performance is assessed using a CQI Performance Index scorecard, which outlines the weighted measures used for scoring.

More details on the HMS-specific P4P Performance Measures:

2025-2026 Pay-for-Performance Resources

2025 (Q1 2025-Q4 2025):

2026 (Q4 2025-Q3 2026):

2021-2024 Pay-for-Performance Resources

2024:

2023:

2022:

  • 2022 (Existing hospitals prior to 2021)
  • 2022 (Hospitals started in 2021)
  • 2022 (New hospitals starting in 2022)

2021:

  • 2021 (Existing hospitals prior to 2020)
  • 2021 (Hospitals started in 2020)
  • 2021 (New hospitals starting in 2021)

If you would like a copy of a past HMS Performance Index, please reach out to HMS-admin@umich.edu.

Value-Based Reimbursement Program (VBR)

The BCBSM Value Partnerships program also supports quality improvement by aligning practitioner reimbursement with quality-of-care standards to enhance outcomes and control costs. Through this initiative, practitioners can earn value-based reimbursement (VBR), which offers payment rates above the standard fee schedule. VBR opportunities are available to PGIP practitioners participating in Collaborative Quality Initiatives (CQIs), such as HMS. Each CQI defines its own performance metrics and scoring methods tailored to its focus area. CQI-based VBR is applied annually and is limited to services provided to BCBSM commercial PPO members. This incentive is in addition to any other VBR a specialist may receive. For HMS, the VBR Program is an optional program and is based on performance and participation in HMS initiatives for physicians in select specialties (Hospitalists, Infectious Diseases Physicians, and Critical Care Physicians).

More details on the HMS-specific VBR Measures:

HMS Physician VBR Eligibility Requirements

To be eligible for VBR, the practitioner must:

  • Meet the performance targets set by the collaborative
  • Be a member of a PGIP Physician Organization for at least one year
  • Submit NPI number to the HMS Coordinating Center via the HMS Biannual Fall QI Survey
2024-2027 HMS VBR Resources

2027 (Payout Period = 2027, Assessment Period = 2026)

2026 (Payout Period = 2026, Assessment Period = 2025)

2025 (Payout Period = 2025, Assessment Period = 2024)

2024 (Payout Period = 2024, Assessment Period = 2023)