PCMH FAQs

Overview

What is the purpose of a PCMH?

A patient-centered medical home (PCMH) is a care team that manages the overall health and coordinates the care of a patient. The PCMH program is designed to assist primary care practices in transitioning to PCMHs through guidance and support, while rewarding them for high-quality, coordinated and efficient care.

Will other Arkansas Blue Cross and Blue Shield plans participate?

Health Advantage fully insured plans, Arkansas Blue Cross and Blue Shield fully insured plans and some self-insured plans began participation in 2015. Medicare Advantage plans began participation in 2020.

Enrollment

Who is eligible to enroll as a PCMH?

Primary care providers (MD, DO, CNS, PA, APN) that are credentialed with Arkansas Blue Cross and Blue Shield who practice in the following areas: family medicine, general practice, geriatrics, internal medicine, and pediatrics.

How does a practice enroll?

Enrollment is held each fall. Practices who are interested in participating can email primarycare@arkbluecross.com to express interest. A Primary Care Representative will provide instructions at the time of enrollment.

Will providers that do not enroll in PCMH be penalized?

No. The PCMH program is voluntary and will not affect your network participation.

Requirements

The practice must be enrolled in the PCMH program, perform all required activities by their respective due date, and meet the majority of quality metrics.

What happens if a PCMH practice does not meet the requirements?

A PCMH practice that fails to complete all activities, or meet the majority of metrics, by their respective deadlines must address their shortfalls or risk program suspension or termination. See the Arkansas Blue Cross and Blue Shield PCMH Provider Manual for more information regarding remediation.

Practice support

There are two financial components to support Practices, care management fees and a performance based incentive. Care management fees are calculated on a per member per month (PMPM) basis for all fully insured plans and some self-insured plans. The performance based incentive (PBIP) began with the 2020 program year and is calculated on quality metrics, utilization, and patient experience of care.

If the number of aligned patients to my clinic changes, will my payment amount change?

For monthly care management fees, yes, the total payment may change monthly based on the number of aligned patients. For the PBIP, because the payment is paid once at the end of each program year, the amount will not change.

Metrics tracked

Will I have to meet all of the metric targets for my Arkansas Blue Cross Plan patients during the program year?

To receive practice support, participating clinics must meet activities and quality metrics. Please see the Arkansas Blue Cross PCMH provider manual for more information.

Reports

Will Arkansas Blue Cross and Blue Shield provide clinic reports?

Yes. Monthly data will be available through the care management portal on AHIN.