In early 2013, the State of Arkansas was awarded a $42 million grant from the Center for Medicare and Medicaid Services (CMS) to implement and test its State Innovation Model. The Arkansas model for a sustainable, patient-centered health care system is based on two complementary strategies—population-based care delivery and episodes-based payment—that are being launched statewide with the support of both public and private insurers.
Under provisions of the plan, by 2016 a majority of Arkansans will have access to a patient-centered medical home, which will provide comprehensive, team-based care with a focus on chronic care management and preventive services. Persons with complex or special needs (e.g., developmental disabilities) will also have access to health homes, which will work with their medical homes to coordinate medical, community, and social support services.
Arkansas will continue to institute and expand its system of episode-based care delivery for acute, procedural, or ongoing specialty care conditions, using a retrospective payment approach that will reward providers who deliver high-quality, cost-effective and team-based care across an entire episode of care. Service for special needs populations will be further enhanced by payments reflecting each client’s assessed level of need.
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Provider payments will include performance-based care coordination fees, as well shared savings for medical homes based on their ability to reduce total cost of care while also achieving goals for quality.
Care coordination fees will be paid on a PMPM basis for attributed patients for the duration of the program to support operational expenses associated with care coordination and practice transformation tools, technology and services.These fees will be tied to demonstrated practice transformation, which will be measured based on merics and milestones used in the Comprehensive Primary Care (CPC) program and expanded to include nationally recognize quality metrics (e.g., by AHRQ) for pediatric care.
Shared savings payments will be paid for quality and efficient management of total cost of care. The program's proposed shared savings model will measure value on a risk-adjusted bases and based on both (a) absolute performance and (b) performance improvement, and reward providers based on the greater of the two amounts. This may be modified as the CPC program defines their shared savings model.
