Value-Based Payment and Procurement Systems

This module will provide high-level knowledge about current Value-Based payment and Value-Based procurement mechanisms, and offer a pragmatic perspective about components for successful Value-Based payment and procurement organizational strategies.

Case Studies

7. Aligning Payers and Providers around Value: Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiatives
Blue Cross Blue Shield of Michigan (BCBSM) is a non-profit mutual insurance company and the largest payer in the State of Michigan in the USA, with over 5.8 million members nationally and a local network of over 150 hospitals and 30,000 physicians. In 2002, BCBSM launched the first of over 20 Collaborative Quality Initiatives under its Value Partnerships program. This unique model formed the basis for a value-based health care ecosystem in the State of Michigan comprising a single dominant payer, an extensive network of providers, and a small number of academic medical centres. In this case study, we describe how this approach has led to improved outcomes for patients and providers and lower costs for payers, benefiting all stakeholders and vastly improving the value of health care in the State of Michigan.

8. How the NHS is leveraging an ICHOM standard set for value-based purchasing
The Bedfordshire Clinical Commissioning Group (BCCG) is the public health care payer for Bedfordshire in England, covering a population of approximately 441,000. In April 2014, BCCG launched a five-year contract for musculoskeletal care with Circle Partnership—a provider network—built on a capitation-based funding formula incorporating financial incentives for delivering improved patient and clinical outcomes. This case study describes the context in which this new contract was developed and how outcome indicators have been incorporated in the contract, as well as the expected benefits and high-level business case.