Providers
In this issue
- Top News
- New Primary Care Representative
- Care Delivery Assessment Results
- ARHOME News
- FEP Update
- Metric Spotlight
- 2025 Quality Metrics
- Did You Know?
- Save the Date!
- Personal Touch
Top News
Introducing New Primary Care Representative
We are very excited to introduce the new Primary Care Representative for the Central Region, Tanikus Farmer. Tanikus has been with Arkansas Blue Cross Blue Shield for 21 years and comes to the Primary Care Department from the Utilization Management Clinic Services and Population Health Department where she was a supervisor for the last 6 years. Tanikus brings with her experience in customer service, analytic skills, as well as team leadership. Tanikus said it was a time for change and to explore opportunities to challenge herself in a way that would help her continue to grow. Tanikus is ready to build relationships with her clinics while working together to meet goals that also meet the needs of our members and the clinics' patients. Tanikus has been reaching out to her clinics to introduce herself and start that relationship. Welcome Tanikus!
Care Delivery Assessment Results
Recently, all clinics enrolled in the 2025 Blueprint Primary Care program completed the Care Delivery Assessment. In this issue, we wanted to highlight some of the answers we received on the question asking what clinics do or plan to do with their Care Management Fees they earn in the program. Here are some of the wonderful answers we received:
- Funding Care Management and hiring a Care Manager to work the program.
- Employ in-house Clinical Pharmacist, Registered Dietician, and a Licensed Social Worker.
- Setting up and maintaining a food pantry in our clinic for patients in need.
- Setting up and maintaining a necessities pantry for our patients in need. Items such as soap, deodorant, toothbrush and toothpaste, shampoo and conditioner, razors, etc.
- Maintaining a full bathroom with a shower and giving patients in need vouchers to use.
- Purchased needed medical equipment to assist with patient care including one large item – new x-ray equipment.
- Purchased a small clinic car along with a driver for patient transportation needs for appointments and pharmacy pick-ups.
- Paid to have front doors replaced with automatic opening doors in the front entrance.
- Set up and maintain a clothing closet for patients in need. Summer items when needed and winter coats, jackets, and shoes when needed.
- Purchased new blood pressure machines for all patient rooms.
- Hired part-time employees to work on gap attestations, quality reports, and researching medical records, patient reach-out for frequent and/or unnecessary ED visits touching base for any needs, patient text campaign reach outs for testing needed, and get annual wellness visits scheduled.
- Set up and provided gym memberships for patients for weight loss and health management.
- Bought a washer and dryer with supplies and giving out vouchers to patients in need of services.
- Maintain a baby supply closet with diapers, formula, baby food, etc. for parents in need.
- Set up and holding education programs for diabetic patients, heart patients, COPD patients, etc.
Did you know that ARHOME plans feature access to Arkansas Blue Cross Blue Shield social workers? For help, call our Social Work Services team at 501-688-0765 from 8 a.m. to 5 p.m., Monday – Friday. If you call after 5 p.m., please leave a voicemail and someone will return your call the next business day.
Blue Cross Blue Shield Association (BCBSA) announced the kickoff of a new collaborative effort for Federal Employee Health Benefit (FEHB) and Postal Service Health Benefit (PSHB) to enhance HEDIS Quality scores in 2025. These are the five critical quality measures that require improvement and emphasize the role of healthcare providers in achieving these goals.
Key Quality Measures Needing Improvement:
- Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
- Controlling High Blood Pressure (CBP)
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Emergency Department Use (EDU)
- Use of Imaging Studies for Low Back Pain (LBP)
These measures have historically scored low and require focused efforts for better health outcomes. Arkansas Blue Cross Blue Shield is seeking the assistance of healthcare providers to improve these two HEDIS Targeted Measures that are part of the value-based program with the Blueprint Primary Care program.
Importance of Blood Pressure Control:
- Prevents heart attack and stroke
- Prevents kidney disease
- Prevents dementia
- Prevents poor birth outcomes
Controlling Blood Pressure (CBP)
Glycemic Status Assessment for Patients with Diabetes:
A Glycemic Status Assessment is important for monitoring and evaluating how well diabetic patients are managing their blood sugar levels. Key reasons include:
- Measures blood sugar control
- Early detection of complications
- Treatment optimization
- Quality metric
Glycemic Status Assessment for Patients With Diabetes (GSD) Formerly HBD
Mid-Year Utilization Target Updates
In 2025 Blueprint Primary Care, Emergency Department Visits per 1000 and Inpatient Admissions per 1000 will be adjusted mid-year. Your patient panels change throughout the year, so the new targets will reflect risk changes and patient panel changes. We believe the mid-year targets will be helpful and will more accurately reflect the risk levels of your current membership. You can expect to see the mid-year targets updated in July.
Metric Spotlight: 2025 Quality Metrics and Targets
| 2025 General Track Claims-Based Quality Metrics | 2025 Targets |
|---|---|
| HTN Controlling Blood Pressure: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHG) during the measurement period. | ≥65% |
| Glycemic Status Assessment for Patients with Diabetes: The percentage of members 18-75 years of age with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was >9.0% during the measurement year. | ≤27% |
| Proportion of Days Covered (Diabetes): The percentage of individuals ≥18 years of age who met the Proportion of Days Covered (PDC) threshold of 80% for diabetes medications during the measurement year. This is a pharmacy measured metric. | ≥70% |
| Breast Cancer Screening: Percentage of female patients 52-74 years of age that had a screening mammogram in the past 27 months. | ≥73% |
| Colorectal Cancer Screening: Percentage of female patients 46-75 years of age that had a screening mammogram in the past 27 months. | ≥60% |
| Cervical Cancer Screening: Women that had appropriate screening for cervical cancer. Two methods for cervical cancer screening are recommended cervical cytology every three years in women 21-64 years of age or cervical cytology/human papillomavirus (HPV) co-testing every five years in women 30-64 years of age. | ≥67% |
| Chlamydia Screening in Women: The percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. | ≥55% |
| Behavioral Health Screening: Percentage of patients 12 years of age or older who were screened for depression or anxiety using a standardized tool during the measurement year. | ≥55% |
| 2025 Pediatric Track Claims-Based Quality Metrics | 2025 Targets |
|---|---|
| Well-Child Visits in the First 15 Months - 6 Visits: Percentage of patients who turned 15 months old during the performance period who receive at least six wellness visits in their first 15 months. | ≥79% |
| Well-Child Visits for Age 15 Months to 30 Months - 2 or More Visits: Percentage: Percentage of patients who turned 30 months old during the measurement year: Two or more well-child visits. | ≥86% |
| Child and Adolescent Well-Care Visits: Percentage of patients 3-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN practitioner during the measurement year. | ≥68% |
| Weight Assessment for Children/Adolescents: Percentage of patients 3 - 17 years of age that had an outpatient visit with a PCP or OB/GYN and had a reported BMI. | ≥60% |
| Weight Assessment and Nutritional Counseling for Children/Adolescents: Percentage of patients 3-17 years of age that had an outpatient visit with a PCP or OB/GYN and had nutrition counseling during the report period. | ≥60% |
| Weight Assessment and Physical Activity Counseling for Children/Adolescents: Percentage of patients 3 - 17 years of age that had an outpatient visit with a PCP or OB/GYN and had physical activity counseling during the report period. | ≥60% |
| Chlamydia Screening in Women: The percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. | ≥55% |
| Behavioral Health Screening: Percentage of patients 12 years of age or older who were screened for depression or anxiety using a standardized tool during the measurement year. | ≥55% |
Metric Specifications and Strategies for all HEDIS metrics are found at www.arkansasbluecross.com/providers/resource-center/hedis-measures. For Blueprint Primary Care metrics, look under the heading Blueprint Primary Care. These strategies include metric descriptions, coding requirements, ages, timeframes, exclusions, documentation requirements and strategies for success.
Behavioral Health and the Importance of Screening
Arkansas Blue Cross and Blue Shield believes strongly in the concept of whole-person health – and that behavioral health is a key component of overall well-being. Arkansas consistently ranks among the lower-ranked states for mental and behavioral health, often in the bottom 10, with a 2024 ranking of 48th in overall health, and facing challenges in access to care and high rates of inpatient stays for mental health conditions.
The 2025 County Health Rankings & Roadmaps report shows that Arkansans reported 6.4 mentally unhealthy days in the last 30 days, compared to 5.1 nationally. The counties with the highest number of mentally unhealthy days in the last 30 days are Poinsett (7 days), Desha, Van Buren, Lawrence, Cleveland, and Searcy (6.9 days), Phillips and Fulton (6.8 days).
Identifying behavioral health symptoms is the first step to treatment. Primary Care Value-Based Programs introduced Behavioral Health Screening as a Quality metric in 2024 and it continues in 2025 Blueprint Primary Care. Screening is recommended for patients ages 12 or older using a standardized screening tool.
Report screening using ICD-10 Codes:
- Z13.31 Encounter for screening for depression
- Z13.32 Encounter for screening for maternal depression
- Z13.39 Encounter for screening examination for other mental health and behavioral disorders
After screening, the provider should review the results, assess the patient’s mental health status, and, if positive, treat or refer the patient, as appropriate. To assist with treatment options, Arkansas Blue Cross and Blue Shield offers a wide range of resources to support providers in addressing needs their patients may have in the areas of mental and behavioral health. Information on resources such as our Integrated Behavioral Health Team, Nurses, Social Workers, Peer Support Specialists, Virtual care options and more are available at https://www.arkansasbluecross.com/providers/mental-health-providers.
Our Behavioral Health Team at Arkansas Blue Cross is made up of dedicated professionals, including nurses, social workers and peer support specialists, who work alongside providers to ensure your patients receive comprehensive care that addresses both their behavioral health and overall well-being.
To refer Arkansas Blue Cross and Blue Shield members for case management services:
Email: [email protected]
800-225-1891
If your patient is experiencing a mental health crisis:
Suicide & Crisis Lifeline
Call or Text 988
Suicide & Crisis Lifeline Online Chat
LGBTQ Youth Crisis Support
866-488-7386 or www.thetrevorproject.org
State and national resources:
AR ConnectNow
Offers short term mental health and substance use services for Arkansas residents
800-482-9921 or https://askarconnectnow.uams.edu/
FindHelp
Access to community resource listings and programs that connect you at free or reduced-cost
SAMHSA’s National Hotline
Confidential, 24/7, 365-day-a-year treatment referral and information service for individuals and families facing mental and/or substance use disorders.
800-662-4357 (800-662-HELP)
Lucet’s Substance Use Hotline
A benefit specifically for Arkansas Blue Cross and Blue Shield members. The Lucet team has licensed clinicians who are available 24 hours a day, 7 days per week. A licensed team member will take time to fully understand and assess potential treatment needs.
877-326-2458
To find behavioral health providers in your area:
- Arkansas Blue Cross and Blue Shield Case Managers
- Call 800-225-1891 or email [email protected]
- National Council for Mental Wellbeing
- Substance Abuse and Mental Health Services Administration
Did You Know?
Provider resources are located at https://www.arkansasbluecross.com/providers.
Behavioral Health resources are located at https://www.arkansasbluecross.com/providers/mental-health-providers.
HEDIS metric specifications are located at www.arkansasbluecross.com/providers/resource-center/hedis-measures.
Previous issues of A Slice of Value newsletter are available at https://www.arkansasbluecross.com/providers/resource-center/newsletter/s/sov-news.
Save the Date!
Blueprint Primary Care Program Training (all virtual)
- May 2 – 4, 2025 REACH Training
- July 16th and 17th Blueprint Primary Care Mid-Year Webinar
Personal Touch: Melissa El Houri
Melissa El Houri, BSN, RN, is the Primary Care Representative for Northeast Arkansas. She started her career with Arkansas Blue Cross Blue Shield in 2022. She received a Bachelor of Science in Nursing degree from University of Central Arkansas.
Her 20-year nursing career includes inpatient medical/surgical, critical care, and recovery. She also worked in a primary care clinic for almost 5 years as their program supervisor. Melissa lives in Beebe with her husband and has a son, daughter, and son-in-law. In her free time, Melissa enjoys traveling to new places in the US and camping.
Primary Care Team
- Missy Davis, Director [email protected]
- Amanda Barber, Manager [email protected]
- Harry Bounds, Primary Care Representative [email protected]
- Melissa El Houri, Primary Care Representative [email protected]
- Tanikus Farmer, Primary Care Representative [email protected]
- Xinyu Li, Data Analyst [email protected]
- Sonya Martin, Senior Data Analyst [email protected]
- Tina Zimmerman, Primary Care Representative [email protected]