The Arkansas PCMH Program

Statewide

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Program Location: 
Little Rock, AR
Number of Practices: 
179
Payer Type: 
Multi-Payer
Partner Organizations: 
Arkansas Health Care Payment Improvement Initiative (AHCPII)
Payers: 
Arkansas BlueCross BlueShield
Arkansas Medicaid
Arkansas State and Public School Employees Plan
QualChoice of Arkansas
Arkansas Health and Wellness Solutions
United
Walmart
Description: 

The Arkansas Patient-Centered Medical Home Program is a key component of the Arkansas Health Care Payment Improvement Initiative (APII) and  is transforming the structure of the state's health care system to control unsustainable growth in costs and reward providers who consistently deliver high-quality, coordinated, cost-effective care to patients. PCMH rewards team-based care and promotes early intervention to reduce complications and associated health care costs. The Arkansas PCMH program builds on the CPC initiative sponsored by CMS, with three successive waves of provider adoption over the course of the coming 2 years. 

As a vital component of APII, the PCMH program complements the progress we have made with episodes of care. The program rewards providers enrolled in the PCMH program who meet defined metrics of care coordination and general practice investment, and who practice transformation. By paying for patient results and outcomes instead of services, Arkansas Medicaid will be able to control costs while improving quality of care. Providers began enrolling in the PCMH program on October 1, 2013. 
 
Highlights from the ACHPII Statewide Tracking Report, January 2016:
  • Approximately 780 primary care providers enrolled
  • 309K Medicaid beneficiaries served representing 80% of eligible Medicaid beneficiaries
  • The vast majority of PCMHs successfully completed 3‐month and 6‐month transformation milestones
  • Anecdotal practice‐level successes and challenges identified throughout the state
Program Website

Related News & Resources

Health Reform Legislative Task Force issues final report
December 2015 - News
Arkansas Medicaid Rewarding Primary Care Providers for Prevention, Disease Management
October 2015 - Resource
The Arkansas Payment Improvement Initiative: Early Perceptions of Multi-Payer Reform in a Fragmented Provider Landscape
June 2015 - Resource
Payment Model: 

The payers in this initiative support primary care transformation through a two-part payment structure: 

Care coordination:

The care coordination payment is risk adjusted (e.g., ranging from $1 to $30 per attributed beneficiary per month) based on factors including demographics (age, sex), diagnoses and utilization. After each quarter, DMS may pay, recover, or offset the care coordination payments to ensure that a practice did not receive a care coordination payment for any beneficiary who died or lost eligibility if the practice lost eligibility during the quarter. 

In order to receive these monthly PMPMs, practices must demonstrate that they have implemented and are performing numerous activities integral to building a medical home structure. These activities include providing 24/7 live voice access to a health professional, identification of and formulation of care plans for high-risk patients, flexible same-day scheduling, installment of meaningful use certified electronic health records, assessment of operations and opportunities for improvement, and other practice enhancements related to a PCMH framework. - AJMC, June 2015

Shared savings:

To receive shared savings incentive payments, a shared savings entity must have a minimum of 5,000 attributed beneficiaries once the below exclusions have been applied. A shared savings entity may meet this requirement as a single practice or by pooling attributed beneficiaries across more than one practice as described in Section 233.000.
 
Click here for more payment information.
Cost Savings: 

Arkansas Department of Human Services (October 2015)

  • In 2014, the state avoided $34 million in Medicaid costs in 2014
  • 19 providers received shared savings payments for a total of over $5 million
Data Source(s): 
Arkansas Department of Human Services (October 2015)
Last updated June 2016
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