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Blueprint Primary Care

We are excited to start 2025 Blueprint Primary Care!  Blueprint Primary Care is founded on the patient-centered medical home model with an advanced payment model. 

There are a total of 335 clinics and 1,967 providers enrolled, spanning across almost the entire state of Arkansas. 

Blueprint Primary Care was formerly known as Primary Care First (PCF).  Arkansas Blue Cross and Blue Shield rebranded the program to Blueprint Primary Care. The name change for 2025 is to avoid confusion with the planned sunset of the Centers for Medicare and Medicaid Innovations’ (CMMI) PCF model at the end of 2025.  Arkansas Blue Cross and Blue Shield plans to continue our value-based program, rebranded as Blueprint Primary Care.  

Blueprint Primary Care is a value-based program founded on the patient-centered medical home care delivery model with an advanced payment model.  The model structure is very similar to the 2024 Primary Care First program.  Notable changes for 2025 Blueprint Primary Care are described in this newsletter under the Metric Spotlight section.

Quality metrics for Blueprint Primary Care General Track focus on controlling chronic conditions and preventive screenings. 

Pediatric Track Quality Metrics focus on preventive measures, aiming to maintain children’s health and detect potential issues early before they escalate into serious conditions.

2024 PCF Utilization Performance-Based Adjustments

Utilization Performance-Based Adjustments earned in Quarter 4, 2024 Primary Care First will be applied to Blueprint Primary Care practices’ Quarter 2, 2025 care management fees beginning in April.  Practices that did not participate in Primary Care First in 2024 will continue to receive base care management fees until Quarter 3, 2025, when all practices receive Quarter 1, 2025 Utilization Performance-Based Adjustments applied to care management fees.

Hot Topics

ARHome - Health & Opportunity for me

ARHome

As part of the commitment to improve the health of ARHOME members, the Blue Wellness Rewards program incentivizes your patients with redeemable gift cards for completing eligible healthy actions. This year, they are excited to expand their activity offerings.

Some new incentives for 2025:

  • Alcohol or SUD treatment and follow-up: Encourages patients to start a path to recovery by rewarding patients that attend a treatment visit and at least one follow-up visit for any substance use disorder.
  • Mental health treatment and follow-up: Stresses the importance of seeking care for mental health conditions by rewarding patients that attend a visit and at least one follow-up visit with a provider. Plus, we offer Arkansas Blue Cross and Blue Shield behavioral health case managers and telehealth options if needed.
  • Using tools to help remember to take mental health medications: Motivates patients to improve adherence to antidepressant or antipsychotic medications by rewarding them for using tools that improve medication adherence, such as medication synchronization, using a local pharmacy or mail order delivery, or switching to a 90-day supply.
  • Starting contraceptive care in women or new post-partum mothers: Supports women to take charge of their reproductive wellbeing by rewarding them for taking contraceptives.
  • Heart failure visit and follow-up: Rewards patients living with congestive heart failure (CHF) for completing two visits with their provider to improve their condition and lifestyle. The initial visit with a provider should educate patients about managing CHF, and the second should be a follow-up to ensure management is successful or adjust as necessary.

The full list of incentives is provided here.

Preventative Care  Adult Preventative Visit$15
Health Risk Assessment$25
Education & Career Readiness Continuing Education$50
Career Readiness Certificate
*Based on skill score achieved		$200 Platinum+ (Level 7)
$175 Platinum (Level 6)
$150 Gold (Level 5)
$125 Silver (Level 4)
$100 Bronze (Level 3)
Community Health Worker Certification$200
Health Management Establish a Primary Care Provider$25
Participate in a Health Fair or Healthcare Community Event$25
Diabetes H1bA1c Follow-up$40
Heart Failure Visit and Follow-up$50
Women's Health Breast Cancer Screening$50
Cervical Cancer Screening$50
Chlamydia Screening$50
See if Contraception is Right for you$25
Mental Health & Substance Abuse Treatment Alcohol or Substance Use Disorder Treatment and Follow-up$50
Using Tools to Health Remember To Take Mental Health Medications$50
Mental Health Treatment and Follow-up$50
Follow-up After Hospitalization or ER Bisit for Substance Abuse Disorder$100
Maternal Care Follow-up with a pregnancy case manager$25
Follow-up with Pregnancy Care Manager$25
Prenatal Care$50 per visit up to $200

Federal Employee Program (FEP)

You may have noticed changes to patients’ Federal Employee Program insurance cards. Beginning January 1, 2025, there are two different cards for FEP and FEP Postal members. FEP Postal member cards have a stamp in the top right corner and a QR code. There is also a new customer service phone number for postal members. It is 844-451-1261.

 

 

 

 

Metric Spotlight: New metrics for 2025

We have three new metrics in our Blueprint Primary Care Program in 2025. Preventive Health Visits (PHV) and Hierarchical Condition Category (HCC) Assessments are pay-for-performance metrics and Chlamydia Screening is a quality metric.

Preventive Health Visit

A Preventive Health Visit is an evaluation and management visit for patients without a chief complaint.  The reason for the visit is not due to an illness or injury but to evaluate the patient’s overall health and to identify potential health problems and identify a new problem with an existing condition.  The visit will include age-related questions to determine risk of illness or certain health conditions and an update of all chronic conditions and maintenance medication.  The payment incentive is in addition to fee for service payments.  Members included in this metric are in the Exchange, ARHOME, and Octave lines of business.

Quality Metric Description

Patients 0-64 years of age who had a preventive or wellness visit performed during the measurement period. Preventive Health Visit incentive will be paid once per year per eligible member covered by an Affordable Care Plan (Exchange, ARHOME, Octave).

Quality Metric Specification

This measure will be collected by Arkansas Blue Cross Blue Shield Claims

Requirements to Fulfill the Measure

Evidence of preventive health visit on claims, based on ICD-10 and CPT codes.

ICD-10 Codes to be used on claims:
  • Z00.00
  • Z00.01
  • Z00.110
  • Z00.111
  • Z00.121
  • Z00.129
CPT Codes to be used on claims
  • 99381 - 99386
  • 99391 - 99396
  • 99461
 Age New Established Z00 Code 
 Infants younger than age 1 99381 99391

Z00.110 - general newborn exam (less than 8 days old)

Z00.111 - general newborn exam (8-28 days old)

Z00.121- routine child exam (more than 28 days old), with abnormal findings*

Z00.129 - routine child exam (more than 28 days old), without abnormal findings

 Ages 1-4 99382 99392

 Z00.121- routine child exam (more than 28 days old), with abnormal findings*

Z00.129 - routine child exam (more than 28 days old), without abnormal findings

 Ages 5-11 99383 99393

Z00.121- routine child exam (more than 28 days old), with abnormal findings*

Z00.129 - routine child exam (more than 28 days old), without abnormal findings

 Ages 12-17 99384 99394

Z00.121- routine child exam (more than 28 days old), with abnormal findings*

Z00.129 - routine child exam (more than 28 days old), without abnormal findings

 Ages 18-39 99385 99395

Z00.00 - general adult exam, without abnormal findings

Z00.01 - general adult exam, with abnormal findings

 Ages 40-64 99386 99396

Z00.00 - general adult exam, without abnormal findings

Z00.01 - general adult exam, with abnormal findings

Live webinars available 

We invite in-network providers and their staff, both clinical and administrative to join us for a live webinar where we discuss Preventive Health Visits covering questions most often asked:

  • When to see your patients for a preventive health visit
  • What a PHV includes
    • Type of exam required
    • Documentation required
    • Screenings
    • Immunizations
    • Vaccinations
  • What to do if a patient comes in for a PHV and you discover an illness or condition that needs to be addressed now.
  • How to address Chronic Conditions in a PHV
  • Preventive health screening vs diagnostic testing
  • Patient roll in a PHV
  • CPT codes that apply
  • ICD-10 codes that apply

What is a preventive health annual care visit

A preventiave health visit is an annual visit for infants, children, adolescents and adults with commercial and Affordable Care Act (ACA) healthcare coverage.

  • The extent and focus of the visit services depend on the age and gender of the patient
  • The reason for visit is not an illness or injury but rather to evaluate the patient's overall health and to identify potential health problems before they manifest and/or identify a new problem with a preexisting condition
  • The visit will include
    •  Age-related questions to determine risk of illness or certain health conditions
      • Screenings (height/weight, hypertension, BMI, cancer, substance use, etc)
      • Tests (hearing, vision, blood sugar, A1c, HIV, etc)
      • Immunizations (RV, DTap, hepatitis A-B, PCV, IPV, MMR, flu, pneumonia, etc)
    • An update of all chronic conditions
      • Active, ongoing (cancer, leukemia, multiple myeloma, etc)
      • Significant to health and function ( diabetes, chronic kidney disease, COPD, hypertension, major depressive disorder, etc)
      • Status conditions (amputations, transplant, ostomy, etc)
      • Congenital/developmental (Down syndrome, autism, Asperger's syndrome, etc)
    • An update of all maintenance medication
      • Listing and linking current medications to conditions which they are taken (prescription, over the counter)
      • Renewal of prescription during appointment (when applicable) to reduce office calls
  • The Affordable Care Act required that most private insurance plans provide $0 coverage for the preventive services recommended by four ACA-designated organizations, specifically:
    • U.S. Preventive Services Task Force (USPSTF)
    • Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP)
    • Women's Preventive Services Initiative
    • Bright Futures

Register below under “Save the Date” to attend one of these free coding webinars available in April!

HCC Assessments

HCC Assessments are completed yearly.  Members included in this metric are also in the Exchange, ARHOME, and Octave lines of business.  Providers will receive data on previously diagnosed conditions.  HCC Assessments are found on the Care Management Portal under the Patient Detail section.  All assessed and present diagnoses should be coded on a claim.  Medical records will be requested to support the HCC Assessments.  Once all requirements have been met, the practices will receive payment.

 

 

Chlamydia Screening in Women

Chlamydia Screening in Women is the new quality metric in the general and pediatric tracks. This metric includes the percentage of members 16-24 years of age who were recommended for a routine chlamydia screening and had at least one test for chlamydia during the measurement year. Patients that are recommended for this screening include those that have had a previous pregnancy test, sexually transmitted disease screening, or a prescription for birth control.   

 

 

Clinic Spotlight: SAMA

South Arkansas Medical Associates is the largest primary care physician group in El Dorado and South-Central Arkansas.  SAMA Healthcare has participated in value-based care for many years.  Their team model has been nationally recognized for its many benefits in patient care.  This design ensures that patients have access to care from their care team members as often as possible, preserving the personal relationship that is critical in providing quality healthcare.

SAMA provides family medical care for all ages, including wellness exams, acute and chronic illness treatment, physicals, laboratory testing, radiology including CT, and preventive maintenance care.  They have six doctors and seven APRNs.  SAMA offers extended hours seven days a week.  The electronic health record they use is Allscripts.

SAMA participates in Blueprint Primary Care in the General Track and is off to a great start with the new HCC Assessment metric.  When asked how they have incorporated the HCC Assessments into their workflow, Susan Taylor, RN, described their process.  She downloads a list of all patients needing an HCC Assessment into an excel spreadsheet and adds a column for upcoming appointment dates.  She checks for patients that are coming in the next day, prints the HCC Assessment forms and gives them to the provider the morning of the appointment.  The provider completes the assessment and gives it back to her.  Susan attests in the portal with the providers’ diagnoses.  The nurses are also working on calling patients that need an appointment.

In January, SAMA completed 35 HCC Assessments!  Susan is the Population Health Manager for SAMA.  Contact Susan if you have additional questions about SAMA’s HCC Assessment process.

Susan Taylor, RN
Population Health Manager
staylor@samahealthcare.com
870-862-2400

 

Save the Date

Blueprint Primary Care Program Training (all virtual)

  • March 5, 2025, at 11:00 AM

Preventive Health Visit Coding Webinars (click on date to register)

Arkansas Behavioral Health Integration Network (ABHIN) Conference

Personal Touch: Amanda Barber

Amanda Barber, MHP, PAHM, is the Manager of Primary Care Programs and has been with Arkansas Blue Cross Primary Care Department for over 5 years.  Amanda served as a Primary Care Representative for the Central Region. 

Amanda has a master’s degree in nutrition and dietetics.  Prior to her work at Arkansas Blue Cross, she spent some time working in clinical nutrition and weight management programs as well as 9 years in practice management for a pediatric practice in North Little Rock.  She worked all areas of the clinic from referrals, front desk operations, billing and office administration. 

Amanda lives in North Little Rock with her husband and 2 daughters. She enjoys spending her time with family, watching her daughters play softball, participating in church events, boating at Greers Ferry Lake, and other outdoor activities like running, walking and biking. 

 

 

 

 

Primary Care Team

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