Arkansas Medicaid Rewarding Primary Care Providers for Prevention, Disease Management
Patient-Centered Medical Homes Approach Helped State Avoid Millions in Costs
LITTLE ROCK – The Arkansas Department of Human Services recognized 19 primary care providers from across the state Friday morning for their work to improve the quality of care they provided patients while also helping the state avoid about $34 million in Medicaid costs in 2014. The 19 providers were awarded a total of over $5 million.
“The checks being presented today represent a real investment in primary care in Arkansas,” said Arkansas Medicaid Medical Director Dr. William Golden. “That investment has not only resulted in Medicaid controlling costs but also tangible improvements for patients.”
The primary care providers who received checks are enrolled in the state’s Patient-Centered Medical Home (PCMH) program, which is part of the Arkansas Health Care Payment Improvement Initiative. Rather than a physical location, a PCMH is a team-based model of care led by a primary care provider.
It promotes preventative care, such as vaccines and wellness checks, while emphasizing the management of chronic conditions as a core component of care. In the first year, there were 659 primary care physicians in 123 PCMH practices enrolled in the program, covering 295,000 Medicaid beneficiaries. Enrolled providers were given a per-member, permonth payment with the expectation that the practice would:
- Better manage patients with chronic conditions,
- Provide more intense care for the top 10 percent of patients with complex medical needs,
- Meet several quality-of-care and technical metrics,
- Provide round-the-clock voice access to clinics and health care professionals,
- Coordinate the care of high-risk patients, and
- Ensure patients get post-hospital stay care.
Because of the enhanced coordination of care for high-risk patients, Golden said, clinicians are reporting patients who are better controlling costly conditions and seeing fewer hospital re-admissions. In addition to per-member, per-month payments, enrolled providers also could qualify for a share of the savings the state saw as a result of the program.
To qualify, practices were required to cover 5,000 Medicaid beneficiaries alone or by pooling with another practice. Of the 120 practices or groups enrolled in the PCMH program the first year, 37 met the 5,000 Medicaid beneficiaries mark.
Nineteen of those clinics or groups additionally met their reporting and quality metrics requirements and were rewarded with shared savings payments in early October in amounts ranging from $8,500 to $927,000.
“The PCMH program has provided UAMS Regional Programs clinics with systems, tools, guidance, and incentives to enhance the care of our patients in all applicable medical areas including acute care, chronic disease management and prevention,” said Tim Hill, UAMS vice chancellor for regional programs. “We look forward to working with DHS in the future to expand our PCMH services both in scope and quality.” Hill said UAMS Regional Programs provides care for more than 18,000 Arkansas Medicaid patients including children, adults and elderly individuals.
