Physician Group Incentive Program
Upper Peninsula Health Group (UPHG) is a Physician Organization (PO) for the Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP). We have been representing practices in connection with PGIP since 2005.
We pride ourselves on our dedicated team of professionals committed to improving patient health outcomes through:
• Supporting & providing guidance on implementation of PGIP initiatives
• Collaborating with member practices
• Offering trainings, webinars, and events
• Providing IT tools like the HealthFocus registry, and Monday.com access for HIPAA compliant data sharing
• $0 fee membership
What is the Physician Group Incentive Program (PGIP)?
It is a BCBSM Value Partnerships program that includes a substantial number of initiatives aimed at improving quality, utilization, and costs. The program connects over thirty physician organizations (POs) statewide to collect data, share best practices, and collaborate on initiatives that improve the health care delivery system in Michigan.
Is there a fee for participating with the UPHG PO?
No, our PO does not charge providers for our services.
What are the types of PGIP Rewards?
• Value-Based Reimbursement (VBR)
• PGIP PO Reward Pool Payments
Once I enroll with UPHG, will I start getting the PGIP Rewards?
Rewards or incentives must be earned through initiative participation and overall engagement, improvement, and/or performance in the program. UPHG distributes reward payments twice yearly to practices that meet specific criteria.
Patient-Centered Medical Home (PCMH)
PCMH is the foundational designation program, focused on process improvement, quality and utilization measure performance.
Clinical Quality (CQ)
PCMH designated practices earn VBR rewards for achieving benchmark performance on HEDIS and STARS measures.
Provider-Delivered Care Management (PDCM)
PCMH designated practices engage patients with chronic conditions, emerging risks, and transitions of care through provider led care coordination and support services.
Specialist Team-Based Care (STBC)
Encourages eligible specialists to adopt a team-based care approach focused on care management and delivering PDCM services, aiming to reduce unnecessary ED visits, hospital admissions, and readmissions.
Collaborative Care Model (CoCM)
PCMH designated practices are trained and engaged in the Behavioral Health CoCM, and can achieve CoCM designation based on CoCM capabilities.
Health Information Exchange (HIE)
Facilitates the secure exchange of health information to improve care coordination and patient outcomes.
Advanced Primary Care (APC) Designation
Recognizes high performing practices who achieves PCMH, PDCM, CoCM & implements required PCMH capabilities to support at-risk members.
Medication Assisted Treatment (MAT)
Expands access to MAT for patients with opioid use disorder.
Specialist Population Health
Uses population based metrics and encourages relationships between specialists/PCPs through improved communication, care coordination, and efficiency in the delivery of care.
Clinical Quality (CQ)
Designed to reward PGIP Patient-Centered Medical Home primary care practices for high performance on select quality metrics.
• Participate with BCBSM’s TRUST PPO or Traditional lines of business and be in good standing with the network/company
• Be an Upper Peninsula Health Plan (UPHP) in-network provider and be in good standing with the network
• Practice with only one provider type (i.e. cannot practice as specialist and a primary care provider)
• Provide patient care at least half time
• Only be attributed to one practice location
• Only participate with one PO for PGIP
• Be committed to practice transformation aimed at improving health care, health care costs, and care coordination
• Agree to implement process changes using an “all-payer approach” (i.e. the care provided to the patients is the same despite the payer)
• Agree to share clinical data as required by PGIP
• Actively participate in the program