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BCBSM and BCN Commercial and Medicare Advantage Contracts Update
MPP (McLaren Physician Partners) has made the decision not to participate in the BCBSM Blueprint model which requires downside risk on commercial or Medicare Advantage patients.
MPP will continue to participate in the Commercial and Medicare Advantage products, the change is there will be no upside gainsharing with BCBSM and BCN effective January 1, 2026. BCN payment withholds of 25% will be eliminated. Other payments based on quality performance will continue.
MPP does not feel it is appropriate to take Commercial downside risk at this time due to the following factors:
- Lack of control over rates in the commercial payor environment
- Uncertainty in political and healthcare environments in Washington D.C.
- Medicare Advantage payors are exiting markets and reducing benefits
MPP will be focusing on improving our quality performance moving forward. We believe there is a $10M opportunity to improve our quality distributions to our providers.
What can you do to help us improve?
- Utilize the Population Health Registry, Persivia CareView or Cerner Health Maintenance, at every visit and discuss closing gaps in care with each patient
- Engage with the MPP Quality team for assistance in identifying patients in need of services
- Utilize the MMG approved Primary Care Standing Orders to allow team-based care
- Review medication lists at every visit for accuracy and to ensure patients are taking medications as prescribed. This is especially important during transitions of care between health care settings.
- Ensure your patients with CVD and Diabetes are taking an appropriately dosed statin medication or include one of the approved exclusion codes on a patient visit claim.
McLaren will stay in the MSSP ACO program with downside risk as we feel CMS rates are more fairly set and the program is stable year-over-year. 2025 is the start of a new 5-year contract which re-sets our coding and spending benchmarks.
We want to thank you for your continued participation and for the delivery of exceptional care you and your practice provide to our patients in the communities we serve.
Please contact me at [email protected] or (248) 484-4923 or your designated quality staff with any questions.
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