Blue Care Network: Follow-up from 2024 BCN/BCNA/MAPPO Gain Share Contracting Meeting

November 14, 2023

Thank you to those of you who could join us on the evening of October 25 for the BCN/BCNA/MAPPO Gain Share Contract and Program updates for 2024. We know some of you had conflicts and were not able to attend, so we recorded the meeting. Due to the size of the file, we are pushing the recording of that meeting through your EDIFECS accounts tomorrow. It sometimes takes several hours for those to go through, so I’d give it until Wednesday to retrieve it.   

We also had a few questions that needed further research. Here are the questions and answers for those items:

Question: Are there any changes anticipated to the risk adjustment program from how it works today?

Answer: For the Advantasure PEC program in 2024, there are no changes to the targets, thresholds, or payment methodology.

Question: If a PO chooses not to allow attribution to APP's, how do you prevent that attribution to the practice? 

Answer: There are two ways:

  1. A PO can choose not to align APPs to their practices in the Portico self-service tool (once it is updated in the spring).
  2. If the APP is enrolled as a specialist (not a PCP), members will not be attributed to that APP.

Question: How will programs such as PDCM and CoCare be affected when APPs will be able to participate as a PCP with the Blues? For example, the Blues want PDCM codes be billed incident to under the physician. 

Answer: APPs are already included in PDCM and they can bill under the PCP. We do not anticipate a change in their billing practice for PDCM.