Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
of the Blue Cross and Blue Shield Association
Collaborative Quality Initiatives Fact Sheet
Value-Based Reimbursement 2026
Anesthesiology Performance and Improvement Reporting Exchange (ASPIRE)
The Value Partnerships program at Blue Cross Blue Shield of Michigan (BCBSM) 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. VBR opportunities are available to all practitioners who participate in the Anesthesiology
Performance and Improvement Reporting Exchange (ASPIRE) regardless of PGIP enrollment. The
coordinating center leaders, jointly with BCBSM, set quality and performance metrics for the VBR. Each
Collaborative Quality Initiative, or CQI, uses unique measures and population-based scoring to receive
BCBSM VBR. The CQI VBR is applied in addition to any other VBR the specialist may be eligible to receive.
The CQI VBR applies only to reimbursement associated with commercial PPO BCBSM members. This is an
annual incentive program.
Population-Based Scoring Methodology
The CQI coordinating center (not the physician organization) determines which practitioners have met the
appropriate performance targets and notifies BCBSM. Each physician organization will notify practitioners
who will receive CQI VBR, just as the PO does for other forms of specialist VBR.
Participants can only receive VBR for one CQI, even if they are participating in more than one CQI, with the
following exceptions:
1) Practitioners that participate in one of the four population-health based CQIs - INHALE, MCT2D,
MIBAC, MIMIND – can receive the related VBR in addition to other CQI VBR
2) Practitioners can receive 102% VBR for tobacco cessation in addition to other CQI VBR. The
tobacco cessation VBR is limited to one reward per practitioner but can be earned in addition to
other CQI VBR.
CQI VBR is not additive if the practitioner is contributing data to multiple CQIs. If a practitioner is eligible for
rewards through multiple CQIs, the practitioner will be awarded the highest level of CQI VBR.
ASPIRE uses a hospital-affiliated scoring model to measure performance. ASPIRE practitioners are grouped
by participating hospital level (physicians are assigned to the hospital where they have performed the most
cases) then measured as a hospital collective average.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
of the Blue Cross and Blue Shield Association
VBR reward opportunities
Participants are scored on CQI performance measures according to the methodologies developed by each
respective CQI and are eligible for CQI VBR of 102%, 103%,105%, or 107% of the standard fee schedule if
they meet performance targets in one or more of those initiatives.
ASPIRE practitioners are eligible for one of the following VBR combinations (102%, 103%, 105%, or 107%)
a. To be eligible for 103% VBR, participants must achieve target on 2 of 3 measures in the
measures listed in Table 1 below.
b. To be eligible for an additional 102% VBR, for a total of 105% VBR, participants must
a. Achieve target on 3 of 3 measures in the measures listed in Table 1 below or achieve
target on 2 of 3 measures (Table 1) and 2 of 2 measures (Table 2). Or
b. Achieve target on 2 of 2 measures in the Tobacco Cessation VBR measures listed in
Table 2 below.
c. To be eligible for 102% Tobacco cessation VBR, participants must achieve target on 2 of 2
measures in the tobacco cessation measures listed in Table 2 below.
d. To be eligible for 107% VBR, participants must achieve target on 3 of 3 measures (Table 1)
and 2 of 2 measures (Table 2).
VBR Measures
Table 1. VBR Measures
Measurement Period
Target
Performance
Percentage of cases with perioperative glucose >180 mg/dL with
administration of insulin within 90 minutes of original glucose
measurement. GLU-11
10/01/2024 – 9/30/2025
>=55%
Percentage of cases where carbon dioxide equivalents normalized by
hour for cases receiving halogenated agents and/or nitrous oxide is
less than CO
2
eq. of 2% sevoflurane at 2L FGF = 2.83 kg CO
2
/hr
during the maintenance period of anesthesia OR the total CO
2
equivalents is less than 2.83 kg CO
2
. SUS-02
10/01/24 - 9/30/2025
>=50%
Percentage of patients who had a procedure requiring general
anesthesia or cesarean delivery and receiving appropriate
prophylaxis for postoperative nausea and vomiting. PONV-05
10/01/24 - 9/30/2025
>=60%
Table 2. Tobacco Cessation VBR Measures
Measurement Period
Target
Performance
Percentage of patients, ≥ 18 years of age, with tobacco status
documented within 30 days prior to any procedure requiring
anesthesia SMOK-01
10/01/24 - 9/30/2025
>=80%
(12-month
average)
Percentage of patients ≥ 18 years of age, who are documented as
current tobacco smokers and receive an approved tobacco cessation
intervention from an anesthesia provider. SMOK-02
10/01/24 - 9/30/2025
>=50%
(12-month
average)
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee
of the Blue Cross and Blue Shield Association
VBR selection process
To be eligible for 2026 CQI VBR, the practitioner must:
● Meet the performance targets set by the coordinating center
● Enrollment in PGIP is not required, but you must be contracted with BCBSM PPO
● Have contributed data to the CQI’s clinical data registry for at least two years, including at least one
year’s worth of baseline data
Are practitioners participating in CQIs eligible for other specialist VBR?
Yes. Specialists are eligible to receive additional VBR if they meet the stated criteria. See the Specialist VBR
fact sheets for specialty-specific information.
About ASPIRE
● Builds collaborative relationships between surgeons and anesthesiologists
● Aims to reduce variation in intraoperative anesthesia practices, resulting in reduced postoperative
complications and costs, and better outcomes for patients. Collects data to measure, report, and
decrease unwarranted variation across several anesthetic domains of care, including:
o glycemic management
o hemodynamic management
o intraoperative ventilation
o neuromuscular blockade
o transfusion management
About the coordinating center
Michigan Medicine serves as ASPIRE’s coordinating center to collect and analyze comprehensive clinical
data from participating hospitals to identify specific care components associated with better patient
outcomes. It uses these analyses to examine practice patterns, generate new knowledge linking processes
of care to outcomes, and identify best practices and opportunities to improve quality and efficiency. The
center also supports participants in establishing quality improvement goals and in disseminating and
implementing best practices. Center leadership:
Program Director: Nirav Shah, MD
Administrative Program Manager: Tory (Victoria) Lacca
Clinical Program Manager: Kate Buehler, MS, RN
For more information on the CQI and measures, please contact Kate Buehler at
kjbucrek@med.umich.edu.