Why Choose Us?
Contract Success
Blue Cross Blue Shield of Michigan (BCBSM) PGIP Program
- ~ 90% of PCPs are PCMH designated
- ~ 80% of specialists receive Value-Based Revenue (VBR)
- In the most recent report, AHA physicians received $4.3M in VBR
- A top-performing group each year for cost efficiency and cost trend scores
Blue Care Network Commercial HMO Five-Year Performance
- A top independent PO in SE Michigan for quality
- Financial performance is best in Michigan
- Total earned surplus: 5-year average: ~$27 pmpm
- Participating: 56 PCPs and 112 SCPs
Health Alliance Plan Commercial HMO Five-Year Performance
- A top performer in quality and utilization
- Financial performance is among the best
- Total earned surplus: 5-year average: ~$18 pmpm
- Participating: 65 PCPs and 160 SCPs
Blue Cross Blue Shield of Michigan Blueprint Contract
- 2024 is 4th year in contract
- Earned cost-target gain share dollars each year
- A top-quality performer
How We Maximize Earnings
- 1:1 coaching with access to technical SMEs
- Performance reporting
- Billing and coding training
- Payer contract support
- EHR integration
- Practice operations optimization
Financial Success
- ~30% increase in value-based payments over last 4 years
- Earned over $23M during the past 4 years
- 90th Percentile for BCN Quality Measures
- 80% of eligible SCPs received BCBSM VBR fee uplift
- The average PCP with 200 patients in each plan would have earned ~$117,000 per year in bonuses
- Specialists average a 10% boost in fees
Management and Performance Reporting
Regularly Delivered Reports
- Gaps-in-Care Report (monthly)
- Pharmacy Summary Report
- Primary Care Physician Financial Performance Report
- Inpatient Admissions Report
- Inpatient Admissions Summary Report
- High-Cost Patient Summary Report
- Emergency Department Summary Report
- High-Cost Patient Claims Report
- High-Tech Radiology Summary Report
- Specialist Cost Summary (1-2 times/year)
- Primary Care Physician – Specialist Office Visit Ratio Summary Report
- Ad Hoc Drill Down Reports
- Plan Specific Quality Data Reports
Your Support Team
- Experienced consultants who have worked with practices – just like yours.
- Michigan residents who care about their communities – just like you.
- Members receive ongoing support and regular check-ins with AHA consultants, who will track the status of key projects and assist staff with quality and performance initiatives.
- Team of consultants in 3 dedicated domains - Quality, Cost, and Risk (three performance pillars based on how all the contracts work) – subject matter experts dedicated to your success in each key area.
Current PO Landscape in Michigan
- Changes in contracting are creating a more competitive environment as health plan payers push more financial risk to the POs and physicians.
- Shift in healthcare contracts from fee-for-service to fee-for-value.
- Blues moving to full-risk contracts and administrative simplification – only want to deal with large, high-performing groups with the infrastructure to take on financial risk.
- Underperforming POs have fewer options than ever and may be excluded from payer programs.
Our members include 318 PCPs and physician members in over 100 sites covering more than 48,000 lives Wayne, Washtenaw, Oakland, Macomb, and St. Clair counties.
Choose our esteemed physician-owned and physician-governed organization in your quest for a professional healthcare affiliation. Within our distinguished network, you'll discover a wealth of resources, unparalleled collaborative opportunities, and comprehensive support services meticulously crafted to ensure your success and the optimal care of your patients.
For further insights on why to choose us, we invite you to contact our office in Michigan at (800) 594-6115.
