Physician Group Incentive Program

DSC_0097cOne of the largest such programs in the U.S., the Physician Group Incentive Program includes nearly 20,000 primary care and specialist physicians in provider-led clinical quality improvement efforts. These efforts impact about 2 million Michigan patients, with PGIP physicians participating in 81 of Michigan’s 83 counties.

The Physician Group Incentive Program connects more than 45 physician organizations from across Michigan to collect data, share information, and collaborate on initiatives that improve the health care system in Michigan.

The Physician Group Incentive Program has expanded in recent years to include efforts that encourage care coordination among primary care and specialist physicians, and a focus on patient outcomes.  Primary care and some specialist physicians who meet quality and population-based care measures are eligible to receive a higher value-based reimbursement, for certain fees.

What makes PGIP so successful?

  • Providers lead the effort. Physicians collaborate with BCBSM to structure the initiatives, based on their clinical and scientific knowledge. This generates credibility and ownership among participants.
  • Program goals are clearly defined. Participants have a clear understanding of the program goals; this keeps participants engaged and better able to track performance.
  • A culture of sharing for continuous improvement is created. Physician organizations throughout the state actively share data and learn from each other in a noncompetitive atmosphere. This fosters clinical guideline developments that improve Michigan’s heath care system.

2017 PGIP initiatives

Participating physician organizations determine which initiatives their physician members will work on each year, and each initiative looks at a specific aspect of health care.

Clinical information technology-focused initiatives

  • Health Information Exchange (Fact sheet PDF) – Supports physician organizations’ participation in a statewide notification service that provides daily, all-payer admission, discharge, transfer and ER census reports on their patients. Additional data types will be added, such as medications at discharge.
  • Patient portal – Develops Web-based portals that allow for improved communication between physicians and patients. Portals provide patient education, access to patients’ medical information and other tools that help manage patients’ chronic conditions.
    Patient portal is a Patient Centered Medical Home initiative
  • Patient registry – Establishes a comprehensive patient registry that is used to manage patients’ health status and ultimately lower health care costs.
    Patient registry is a Patient Centered Medical Home initiative
  • Electronic Prescribing of Controlled Substances(Fact Sheet PDF) Encourages physicians to increase their electronic prescribing of controlled substances, which increases safety.
  • Telehealth(Fact Sheet PDF) Launched in April 2017, the Telehealth initiative encourages physicians to use telemedicine, online visits and telemonitoring to provide patients with additional points of access.

Service-focused initiatives

  • Patient Experience of Care(Fact sheet PDF) – Supports physician organizations as they develop a common statewide method to assess and report patient experience of care with physicians.
  • Resouce Stewardship Initiative (Fact sheet PDF) – Encourages participants to reduce the use of certain services, procedures and tests that may be overused or have questionable value.

Core clinical process-focused initiatives

  • PGIP Clinical Quality Initiative (Fact Sheet PDF) – Encourages and incentivizes physician organizations in implementing a set of evidence-based medical guidelines, to improve overall quality and a subset of Health Effectiveness Data and Information Set measures.
  • Coordination of care – Coordinates patient care across the whole spectrum, including collaborating with specialists and other care providers, and communicating with patients and caregivers.
    Coordination of Care is a Patient Centered Medical Home Initiative
  • Extended access – Ensures patients have “extended access” to the doctor practice through operational changes. This may include 24-hour phone access, after-hours access and additional language capabilities.
    Extended Access is a Patient Centered Medical Home initiative
  • Individual care management –  Helps physician practices better manage patients’ care by helping them to establish multi-disciplinary, integrated teams to provide care management, offer planned visits and group visits, and ensure follow-up on needed services.
    Individual Care Management is a Patient Centered Medical Home initiative
  • Integrating Behavioral Health into General Medicine Care (Fact Sheet PDF) – Encourages physician organizations in coordinating patient care with behavioral health specialists.
  • Linkage to community services – Assists patients in receiving  receiving needed community services through a systematic process for referrals and follow-up.
    Linkage to Community Services is a Patient Centered Medical Home initiative
  • Patient-provider partnership – Participants create and use a patient-provider agreement or documented patient communication process regarding mutual roles and responsibilities in the patient-centered medical home.
    Patient-provider Partnership is a Patient Centered Medical Home initiative
  • Performance reporting – Improves service efficiency and patient experience by establishing reporting methods to help physician organizations and practices track and manage processes and outcomes of care.
    Performance Reporting is a Patient Centered Medical Home initiative
  • Preventive services – Helps patients manage their health, control their condition(s), and prevent complications through preventive measures counseling.
    Preventive Services is a Patient Centered Medical Home initiative
  • Self-management support – Teaches patients self-management skills for chronic conditions by improving physician patient education strategies and techniques.
    Self-management Support is a Patient Centered Medical Home initiative
  • Specialist referral process – Improves the speed and efficiency of referring patients to specialists, and helps to ensure that all providers receive timely patient information for providing optimal patient care.
    Specialist Referral is a Patient Centered Medical Home initiative
  • Test tracking and follow-up – Develops processes for tracking patients’ test results and following up with patients who need additional attention.
    Test Tracking and Follow-up is a Patient Centered Medical Home initiative

Physician Organizations