The Value Partnerships program at Blue Cross Blue Shield develops and maintains quality programs to align practitioner reimbursement with quality-of-care standards, improve health outcomes, and control health care costs. Practitioner reimbursement earned through these quality programs is called value-based reimbursement (VBR). The VBR Fee Schedule sets fees at greater than 100% of the standard fee schedule. Please note that the MOQC VBR is in addition to the subspecialty VBR. MOQC VBR opportunities are available to practitioners enrolled in PGIP.
Each year the MOQC Coordinating Center’s Measures Committee proposes a set of measures to be eligible for VBR the following calendar year. The measures are then reviewed and approved by BCBSM. There are often 3-4 VBR measures per year and each measure has a specific target that must be met.
MOQC would like to highlight for 2022 (VBR eligibility 2023), there are additional fee schedule increases for meeting measures for eligibility up to 7%.
Please visit the VBR area of the website for more details.
VBR Performance Measures for 2022 (for VBR Eligibility in 2023)
| LEVEL | VRB MEASURE AND TARGET | CQI VBR |
|---|---|---|
| Collaborative Meet 2 of 3 | Tobacco cessation counseling administered or patient referred in the past year - 75% | Additional 2% |
| Proportion of patients with smoking status recorded – 90% | ||
| Proportion of patients with smoking treatment recorded – 30% | ||
| Region Meet 3 of 4 (Med Onc) | NK1-RA or olanzapine overuse – 10% (or lower) | 3% |
| NK1-RA and olanzapine underuse – 25% | ||
| Hospice enrollment – 50% | ||
| Hospice enrollment within 7 days of death – 30% (or lower) | ||
| Region Meet Both (Gyn Onc) | Decrease outpatient prescribing of opioids for cancer patients after laparoscopic or open hysterectomy using a patient-specific calculator based on risk factors - 9 pills or fewer | 3% |
| Days from debulking surgery to chemotherapy start - 28 days or less | ||
| Practice Meet Both (Med Onc) | Meet all 4 of the above 4 VBR measures | Additional 2% |
| Race and ethnicity data documented in the oncology record - 90% | ||
| Practice Meet Both (Gyn Onc) | Meet both gyn/onc measures | Additional 2% |
| Race and ethnicity data documented in the oncology record - 90% |
Additional Criteria for receiving VBR – Medical Oncology Practices
| LEVEL | CRITERIA |
|---|---|
| Practice Level | At least one physician and one practice manager from the practice must attend both MOQC regional meetings and at least one Biannual meeting during that year |
| Physician Level | Provider must have been enrolled in PGIP for at least one year |
Additional Criteria for receiving VBR – Gynecologic Oncology Practices
| LEVEL | CRITERIA |
|---|---|
| Practice Level | At least one physician and one practice manager from the practice must attend both MOQC gynecologic oncology meetings during that year |
| Physician Level | Provider must have been enrolled in PGIP for at least one year |