Chiropractic care is a unique piece of whole person care, and chiropractors are in a valuable position to ensure the delivery of services are appropriate and effective for patients.
As a BCBSM chiropractor in Michigan, do I have to participate?
No, chiropractors are not required to engage in the low back pain imaging initiative. If a chiropractor chooses not to opt-in, they will not be eligible for the 5% LBP VBR opportunity, and their information will be excluded from the analysis.
Do I need to be in a Physician Organization (PO) to participate?
All Michigan chiropractors may participate in this opportunity if they are Blue Cross Blue Shield of Michigan PPO participating providers, in good standing. This opportunity exists for these chiropractors, regardless of whether they are participating in PGIP or not. BCBSM practitioners may become ineligible for value-based reimbursement if Blue Cross Blue Shield of Michigan places them on a corrective action plan (Prepayment Utilization Review - PPUR).
I opted-in, what is the downside if my region’s target/performance is not achieved?
If a region does not meet the target or performance improvement goal, the enrolled chiropractors will not receive the 5% VBR. There is no other impact to an enrolled chiropractor’s existing reimbursement or standing with BCBSM.
I did not opt-in by June 30, 2025. What are my options?
Chiropractors who did not opt-in by June 30, 2025 are ineligible for the 2025 measurement year opportunity. In 3rd quarter 2025 BCBSM/MDC will release preliminary plans for future opportunities. Stay tuned!
How were the targets and improvement goals set for the 2025 measurement year opportunity?
BCBSM and MDC utilized NCQA benchmarks and evaluated the statewide and regional level performance between 2022 and 2023 to determine achievable improvement opportunities.
What is Value-Based Reimbursement?
Value-Based Reimbursement (VBR) offers the opportunity for providers participating in BCBSM’s PPO network to earn greater than the standard professional fee schedule, based on achieving goals related to this opportunity. The Value-Based Reimbursement Fee Schedule (as noted in the BCBSM Trad and TRUST provider contract language) adjusts the BCBSM PPO professional approved amount for appropriate services. This new VBR opportunity is available to all BCBSM Book of Business chiropractors.