Innovation means taking something that works and making it work even better. At Blue Cross Blue Shield of Michigan, we aren’t satisfied that one of the most expensive health care systems in the world isn’t delivering affordable health care. We believe innovation is a key to fixing what isn’t working — and making something good even better.
Innovation starts with changing how we do things as a health care system to make sure health care is affordable and accessible for you. It’s about rethinking how care is delivered, paid for and accessed to make it more affordable, effective and sustainable. From new treatments and cutting-edge medicine to smarter payment models and system-wide improvements, we are committed to leading change that benefits everyone.
Smarter, More Affordable Care
We’re investing in new ways to deliver care that make it more convenient and cost-effective while focusing on the prevention of serious illness.
▪ Expanding Telehealth & Virtual Care: We are making it easier for our members to see a doctor anytime, anywhere. We are reducing unnecessary emergency room visits and saving money. Since 2020, telehealth use has increased by 72% among Michigan providers.
▪ AI & Predictive Analytics: We are using data-driven insights to flag our members’ health risks before they become costly crises — like identifying members at high risk for kidney disease or hospital readmission.
▪ Whole-Person Health Approaches: We are integrating mental health and physical health into the primary care doctor’s office — providing coordinated support for chronic conditions and tackling factors like food insecurity and transportation that impact health outcomes.
These innovations lead to healthier members and lower costs for everyone.
Paying for Better Health, Not Just Health Care
The old way of paying for health care — “fee-for-service" — rewards providers for prescribing more tests and procedures with higher payments. You don’t need to be an expert to notice the increase in health care costs during the past 100 years — well beyond inflation — is not working. It’s obvious. So, we’re changing it. We’re leading the transition to value-based care:
▪ Blueprint for Affordability: We launched a groundbreaking program that aligns payments with outcomes. It’s saved $93 million in just three years by rewarding high-quality, efficient care. This is money that otherwise would have flowed right to your health insurance premium.
▪ Value Partnerships: We collaborate with Michigan providers — 20,000-plus physicians and 100-plus hospitals — to lower unnecessary costs and improve patient care, preventing $6.3 billion in medical expenses that didn’t affect your health insurance costs—but would have.
▪ Bundled Payments & Shared Accountability: We are encouraging providers to coordinate care and eliminate waste by ensuring they’re accountable for total patient health, not just individual procedures. Before, the financial risk associated with inefficient health care was yours it was felt in your insurance premium. Now, that risk is shared by providers and insurers — and incentivizing us to work together on your behalf to make sure expensive medical care actually works.
These payment models drive down costs while improving quality.
Making Cutting-Edge Medicine More Affordable
New treatments and therapies are transforming health, but many come with high price tags. We are working to balance access, innovation and affordability by leading in:
▪ Enabling YesRx: Blue Cross, in partnership with other Michigan health systems, has enabled the development of YesRx – an organization that improves cancer medication access for vulnerable cancer patients lacking financial means to pay for cancer medications. YesRx increases access to free cancer medications and prevents waste. More than $14 million in medication to date has been provided to Michigan patients at no cost.
▪ Cellular & Gene Therapies Management: We negotiate contracts with drug manufacturers to ensure we, our customers and our members only pay for these medications that can cost $1 million or more when treatment is successful. Our plans include annual out-of-pocket cost limits to help protect our members and group customers financially.
▪ Effective Medical Policy: We have a rigorous medical policy management process in place to ensure that members have access to medical technologies and interventions that improve health. This physician-led, multi-disciplinary process ensures that Blue Cross is using the latest clinical evidence and guidance from professional associations in determining if an intervention should be deemed investigational or established.
▪ Biosimilars & Drug Cost Reform: We are promoting lower-cost alternatives to expensive biologic drugs. We are advocating for increased biosimilar adoption to drive down prescription drug costs. Through Price Edge and other drug discount programs, Blue Cross and Blue Care Network members saved more than $59.6 million on eligible drugs in 2024.
By investing in driving biosimilar adoption, effective medical policy and expanding quality initiatives, Blue Cross is leading efforts to make advanced medical treatments more affordable and effective for our members.
Breaking Down Barriers & Cutting Waste
We are responsible stewards of our members’ health care dollars. We’re working to streamline systems that protect our members and ensure they receive the right care at the right time while preventing waste, fraud and abuse.
▪ Prior Authorizations: We are reducing the time it takes us to approve payment for treatments while ensuring the right care at the right time, preventing dangerous drug interactions and preventing fraud.
▪ Digital Engagement: We are providing our members’ real-time cost estimates, personalized health coaching and easy appointment scheduling through online and mobile platforms.
▪ Administrative Efficiencies: The cost of running our own business consumes just nine cents of every health care dollar. Still, we are working toward a goal of reducing our own administrative costs by $600 million while promoting greater efficiency so more of the health care dollar goes toward our members’ care.
We Need to Do More—And We Will
We’ve made real progress in transforming health care, but there’s much more to do.
Health care remains too expensive, too complex and too slow to change. That’s why we’re committed to continuing to innovate — across care delivery, payment models, treatments and system-wide improvements.
At Blue Cross Blue Shield of Michigan, we’re not waiting for innovation in health care — we’re creating it. Because real innovation doesn’t just make care better; it makes it more affordable for everyone.
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