Specialty Care Reimagined Support

This page contains educational resources to help ensure your success as a provider with Blue Shield's Specialty Care Reimagined program

Specialty Care Reimagined program overview

Specialty Care payment model manuals 

These comprehensive manuals explain value-based care and the Specialty care payment model using simple graphics and examples. You may review this manual in its entirety or use the clickable table of contents to navigate to the content you need.
 OB/GYN Maternity Episodes of Care Payment Model (PDF, 5 MB)
 Gastrointestinal Episodes of Care Payment Model (PDF, 5 MB)
 Orthopedic Episodes of Care Payment Model (PDF, 8 MB)
 Cardiac Episodes of Care Payment Model (PDF, 7.7 MB)
 

Specialty Care Reimagined payment model webinar 

These webinars provide a deep dive into the various Specialty Care Reimagined payment models.
  OB/GYN – Maternity payment model (27 min)
  Gastroenterology payment model (35 min)
  Orthopedics payment model (26 min)
  Cardiac payment model (11 min)
 

Specialty Care Reimagined: Contacts list

The following resources are available to help answer your questions or provide you with more information. Thank you.

Help or information: carereimagined@blueshieldca.com

Value-based reporting training

Monitoring report user guide

Monitoring reports will be produced monthly to provide your practice with the most up-to date data to help you optimize patient care and track financial and quality progress.
 

Monitoring report tutorials

Watch these videos to learn how to utilize your monitoring reports to track progress to goals and areas of opportunity.
 Gastrointestinal monitoring report tutorial (8 min)
 Maternity monitoring report tutorial (10 min)
 Orthopedic monitoring report tutorial (9 min)
 Cardiology: Coming Soon!

Playbooks and coding support

Playbooks

A playbook is a detailed guide to each episode. This provides an overview of the Episode framework along with specific CPT codes that are included within each model.

See attached “Playbooks”

Cardiology:
 Percutaneous coronary intervention playbook (Excel, 606 KB)
 Coronary artery bypass graft surgery playbook (Excel, 738 KB)

Gastrointestinal:
 Endoscopy playbook (Excel, 484 KB)
 Colonoscopy playbook (Excel, 473 KB)

Maternity:
 Maternity playbook (Excel, 2 MB)

Orthopedics:
 Knee arthroscopy playbook (Excel, 869 KB)
 Knee replacement playbook (Excel, 952 KB)
 Hip replacement playbook (Excel, 955 KB)
 Lumbar spine fusion playbook (Excel, 548 KB)
 Lumbar laminectomy playbook (Excel, 525 KB)
 Shoulder replacement playbook (Excel, 520 KB)
 Shoulder arthroscopy playbook (Excel, 615 KB)
 

Coding support – maternity metrics

This coding document provides information about how to code appropriately so your practice receives credit for the work you do to improve patients' health in our Maternity model.

See Maternity Quality Metric document
 Maternity coding guide (Excel, 45 KB)