Blue Cross and BCN align primary care provider contracting entities

Blue Cross Blue Shield of Michigan and Blue Care Network are asking primary care providers to align Blue Cross and BCN contracting under the same Blue Cross physician organization, or PO, and its corresponding BCN medical care group, or MCG. This alignment needs to occur on or before Jan. 1, 2026.

Beginning in 2026, one PO, that includes an affiliated MCG, will support a primary care provider for all of the Blue Cross and BCN lines of business in which the primary care provider chooses to participate. This includes Blue Cross and BCN commercial and Medicare Advantage plans (Medicare Plus Blue℠ and BCN Advantage).

“Physician organizations are the cornerstone of how we help support physicians in value-based contracts, value-based reimbursement and incentive programs,” said Amy McKenzie, M.D., vice president of clinical partnerships and associate chief medical officer at Blue Cross.  “A high-functioning physician organization helps its physician practices to be successful by providing the infrastructure necessary for practices to thrive in an increasingly value-based environment with expanding data and quality requirements. Moving to a single PO platform can facilitate improved care, strengthen administrative systems and enhance data analytics, resulting in better patient outcomes.”

Sue Burns, senior director of provider network contracting, management and support for Blue Cross, agrees. “Having a primary care provider in one physician organization for Blue Cross business and that PO’s affiliated medical care group for BCN business will help simplify both internal and external support for contracting, strengthen physician support systems and streamline reporting. Having a single contracting entity representing a provider across all lines of business creates synergies in total population health management.”

What this means for you

Primary care providers will need to align themselves with a PO for purposes of any Blue Cross commercial and Medicare Advantage (Medicare Plus Blue) value-based contracts and that PO’s corresponding BCN MCG for HMO commercial and Medicare Advantage (BCN Advantage) contracts.

Here’s what you may need to do.

• If you’re already part of a PO and MCG that align, you don’t have to do anything further. If you have questions about this, contact your PO.

• If you’re not already part of a PO or MCG, review the list of POs and their corresponding MCGs and reach out to them to ask about their participation requirements, including the benefits and services they offer.

• If you’re with a PO for Blue Cross contracts and an MCG that doesn’t align to that same PO for BCN contracts, you’ll need to determine which entity you will align with going forward. You’ll have to choose one, so your PO and MCG are aligned. Talk to both entities to ensure you make an informed choice.

• If you’re a primary care provider in the Upper Peninsula, you don’t need to align with a BCN MCG, as there is currently not a corresponding MCG to the Upper Peninsula Health Group PO.

If you don’t already participate with all of the Blue Cross and BCN commercial and Medicare Advantage provider networks and wish to join, go to bcbsm.com/provider, click on Enrollment and follow the instructions to find, sign and submit the applicable signature documents.

Primary care providers can reach out to their existing POs or ask any PO about its participation requirements, including the benefits and services it offers. A list of the POs, their contact people and their corresponding MCGs, is available on our website.

Note:

• A primary care provider can participate in the Blue Cross networks without aligning to a PO.

• In some cases, a primary care provider maybe able to participate in the BCN and BCN Advantage networks without aligning to a PO and MCG entity, but participation is limited based on the needs of the network.

Benefits of the strategic change

POs work with practices or individual providers to improve performance and maximize value-based reimbursement and incentive opportunities, as well as to provide administrative support. If a primary care provider is aligned under one PO and MCG entity across all product lines, it maximizes the time and resources of the PO, MCG and primary care provider.

Reporting on the same group of providers across product lines leverages economies of scale to better identify opportunities for efficiency and cost savings. The primary care provider has fewer entities to work with and reduced administrative burden, resulting in more time for patient care.

Timing and Next Steps

Please consider your current situation and your options. Although alignment under one PO and MCG is not required until Jan. 1, 2026, primary care providers can make changes now. There will be a cutoff date communicated to allow the PO to submit changes and ensure all updates are processed by the effective date.

Primary care providers will continue to be able to change their PO and MCG affiliations in the future. Primary care providers must have agreements with their POs and MCGs, which will submit the appropriate information to Blue Cross and BCN to initiate the updates.
If you have questions about your options and are affiliated with a PO or MCG, please reach out to your contact at that entity directly.

We appreciate all the work our health care providers do to care for our members. These changes will better support primary care providers across all Blue Cross and BCN lines of business.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.