1. Arkansas Health Care Payment Improvement Initiative (AHCPII)
National Association of State Human Services Finance Officers
July 30, 2014

2. We face major health care challenges in Arkansas
Navigation challenges in the health care system
Hard for patients to navigate
Does not reward providers who work as a team to coordinate care for patients
Fragmented provider system
Many independent providers
>60% physicians in practices of 5 or fewer
Mix of rural and urban populations
About 40% of Arkansans in rural areas
Health care system not integrated
Low rankings on national health indicators
Ranked at or near the bottom of all states on national health indicators, such as heart disease and diabetes
We face major health care challenges in Arkansas

6. DCO-AAA
The episode-based model is designed to reward coordinated, team-based, high quality care for specific conditions or procedures
The goal
Coordinated, team-based care for all services related to a specific condition, procedure, or disability (e.g., pregnancy episode includes all care prenatal through delivery)
Accountability
A provider ‘quarterback’, or Principal Accountable Provider (PAP) is designated as accountable for all pre-specified services across the episode (PAP is provider in best position to influence quality and cost of care)
Incentives
High-quality, cost-efficient care is rewarded beyond current reimbursement, based on the PAP’s average cost and total quality of care
Provider Stories:
Coordination: Perinatal Hospital Stays
Pathology - Placentas
Drug Screens – Identified case of full drug workup on all patients

10. All but URI, ADHD, and ODD are multi-payer

11. Episodes Progress to Date
Completed first performance period reconciliations for URI, ADHD, Perinatal, CHF, and TJR in April 2014
Significant enhancements in provider, portal, episode, documentation and technical refinements to existing algorithms
Discussions underway to apply lessons learned to refine existing episodes and develop base definitions for future waves
Providers
Produced over 15,600 Principle Accountable Provider (PAP) reports for nearly 2,000 distinct providers representing approximately 227 million claims
Changing specialist and facility referral patterns
Impact
Increased screening for diabetes, HIV, Hepatitis B and other conditions in pregnant women
A 29% drop in ADHD episode costs for Oct – Dec. 2012
Improved coding and oversight of stimulant medication to ensure prescriptions match diagnoses
Stabilized costs for CHF and TJR
A 19% decrease in unnecessary antibiotic prescriptions for URI for Oct – Sept. 2013
An 18% reduction in multiple courses of antibiotics prescribed for sinusitis and other URIs
In addition to total cost of care, here are a few key shared savings terms that are important to understand.
New Portal Functionality: (e.g., random sampling for quality metrics, confirmation view and print capability for provider entries)

13. While only 3-5% of health care dollars are spent on primary care services, a PCMH PCP influences nearly all of health care expenditure

14. Patient Centered Medical Homes will support patients to connect with the full constellation of providers who form their health services team…
What is PCMH?
Key Attributes
24/7 access for all individuals
Evidence-informed care
Providers with responsibility for a practice’s entire population
Coordinated and integrated care across multidisciplinary provider teams
Focus on prevention and management of chronic disease
Referrals to high-value providers (e.g., specialists)
Improved wellness and preventative care
A team based care delivery model led by a primary care provider that holistically manages a patient’s health needs
Incentives
Monthly fees to support care coordination efforts and ramp-up of PCMH model
Shared savings model that rewards providers for controlling costs while maintaining or improving quality

18. PCMH Progress to Date
PCMH
Exceeded 2014 enrollment target of 40% of eligible beneficiaries
79% of eligible beneficiaries (289K) enrolled through second enrollment period1
20% of PCMHs opted to pool for shared savings, and pooling will be expanded next year
62 PCMHs (93 individual sites) are enrolled with practice transformation vendor
Practice transformation vendor is helping providers meet activity requirements
Program has been adjusted and improved based on provider feedback regarding reports, the portal, and model design
Providers
Metric performance demonstrates opportunity for growth among PCMHs
Quality targets are within reach for most PCMHs
Additional metrics, care category cost information and peer comparison, and shared savings reports have all been added since first reports
Impact
Expanding functionality of portal enables providers to:
Review PCMH statistics and compare to peers
Select high priority beneficiaries and exclusions
Document practice support activity approach
Record care plan status for high priority beneficiaries
1 Includes enrollment in PCMH and CPCi programs

19. Lessons Learned
Design and development
Ensure multi-payer consistency for design to maximize clarity and impact for providers
Standardize design elements as much as possible to streamline development
Create thorough documentation of requirements and design approach (including for reports and provider portal inputs)
Implemen-tation
Don’t expect perfection in the first version. Plan for maintenance and revision of the models.
Follow up on missed quality metrics (to ensure failure isn’t due to lack of data)
Provider engagement
Maintain early and frequent/ ongoing engagement with the provider community (e.g., local clinical input for design, outreach prior to implementation, monthly touch points with AHA and AMS)
Providers respond to gain/risk sharing – in some ways positively (e.g., clearly adjusting behavior), and in some way to benefit from the system (e.g., adjusting coding behaviors)

20. For more information regarding AHCPII . . .
DCO-AAA
For more information regarding AHCPII . . .
Online
More information on the Payment Improvement Initiative can be found at
–Further detail on the initiative, PAPs, and portal
–Printable flyers for bulletin boards, staff offices, etc.
–Specific details on all episodes and PCMH
–Contact information for each payer’s support staff
–All previous workgroup materials
– Link to new AHCPII video
Medicaid: (in-state) or (local and out-of state) or
Blue Cross Blue Shield: Providers , direct to EBI ,
QualChoice: ,
Phone/
Dawn (Zekis) Stehle Director of Health Care Innovation/Interim Medicaid Director
Today’s Presentation