BlueCross BlueShield of Western New York is offering a new plan to small groups for January 2021 that will include a network of high-performing provider practices. Only small groups (1-100 members) in Erie and Niagara Counties will have the option to choose Apex.

The network will be limited to only the highest performing primary care physicians (PCPs) and specialty groups who practice in those same counties. Not all specialty groups will be limited, in order to ensure that patients have adequate access to a variety of providers.

The limited network includes:

• Top 40% of Erie and Niagara County primary care network groups (based on quality and efficiency, as measured in BestPractice)
• Top 90% of all Erie and Niagara County specialty groups (based on Cave Consulting Group analytics)  

Providers will receive a contract amendment to Attachment A of our standard provider agreement by December 1, 2020. The amended Attachment A will indicate whether a provider is included in the Apex network. 

Cave analytics

Cave Consulting Group is an independent company focused on improving effectiveness (quality-of-care) and efficiency (cost-of-care) in the health care delivery system. Health plans throughout the nation use their comprehensive analytical tools to generate practice-level reports. Cave produces reports that analyze our claims data to provide a better understanding of area specialty provider quality and cost.