Read this article about Blue Cross Blue Shield of Michigan, one of our finalists, in the category Best Achievement of Operational Excellence Project under 90 Days, selected by the independent judging panel, for the 2019 Business Transformation & Operational Excellence Industry Awards program. Click here to read articles on other finalists.

Medicare Advantage Attribution

Under contract to the Centers for Medicare and Medicaid Services (CMS), Blue Cross Blue Shield Michigan (BCBSM) markets and manages Medicare Advantage (MA) products to individuals age 65 and older and is the 6th largest Medicare Advantage plan in the country. Like all health insurance products, MA plans are based on trusted relationships – between patients, physicians and health plans. These relationships establish a fundamental association for the maintenance of health and the delivery of care. The data supporting and defining these relationships is a critical underpinning to MA health plans, as the relationship between a member and their primary care physician (PCP) is the basis for defining accountability to: (1) a member’s health and (2) performance-based measurement and reimbursement to physicians. This alignment of a member to a PCP in an MA Plan is known as MA Attribution.

In response to critical feedback from some physicians, in early 2018, BCBSM recognized the organization’s MA Attribution process needed to improve. Incorrect MA Attribution was hindering BCBSM’s ability to determine physician performance, timeliness and cost of care metrics. Payments to physicians were delayed and in some cases inaccurate, resulting in physician frustration. Additionally, members received erroneous communications. For BCBSM, gaps in care remained unresolved, lowering plan quality scores and resulting incentive payments.

Evaluation revealed lack of understanding of the required steps and proper sequencing of the process. A cross-functional team was assembled to examine the process and make recommendations for repeatable improvement. To achieve quick results, leadership determined a Kaizen event would efficiently optimize the process, providing a structured problem-solving methodology engaging all stakeholders across the end-to-end process. The event enabled the team to identify a portfolio of improvement opportunities within two days, rather than traditional improvement projects which could extend four to six weeks.

The team transitioned quickly to implement the identified actions. An action plan tracker was used in meeting with the initiative teams to monitor progress and enforce accountability. A cadence of touchpoints with executives ensured momentum was sustained and obstacles were cleared promptly. All action items were completed within 8 weeks, and the future state was fully operational upon completion.

The improved process resulted in more precise MA Attribution for the 14% of BCBSM's total MA membership where inaccuracies were discovered. This improvement has increased the quality and accuracy of every program and/or payment that is consuming MA Attribution data. To illustrate the improvement scope: The team identified six payment programs, totaling more than $60 million in payments. Increased MA Attribution accuracy has improved the overall correctness of payments across these respective programs.

Positive business results must equate to positive member results. This project also delivered on that. Improving MA Attribution accuracy enhances the relationship between members, physicians and BCBSM. With accurate MA Attribution, members get timely, efficient health care, delivered cost-effectively that improves their overall quality of care, and their quality of life.