Approximately 100 area health care providers attended a Wednesday presentation on the Arkansas Health Care Payment Improvement Initiative at Jefferson Regional Medical Center. Panelists included Arkansas Surgeon General Dr. Joe Thompson, Arkansas Children’s Hospital Director of Medical Sciences Dr. Andy Allenson, and Blue Cross and Blue Shield Insurance Executive Vice President Steve Spaulding.
The state Health Care Payment Improvement Initiative is designed to help transform the structure of Arkansas’ health care system, according to informational materials distributed at the event. The initiative’s purpose is to “control unsustainable growth in costs and to reward health care providers who consistently deliver high-quality, coordinated, cost-effective care to patients.”
The program is described as part of a federal effort to reward health care providers that improve services for Medicare patients. The four-year project is a product of the 2010 federal health care law aimed at reducing costs and improving health care delivery, and will be administered by Medicare’s Innovation Center. Initial participating regions include Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District, the Cincinnati-Dayton Corridor, and Tulsa, Okla.
Here, the program features a collaborative effort among health care payers Arkansas Medicaid, Arkansas Blue Cross and Blue Shield, and QualChoice of Arkansas. The initiative is introducing an “episode-based” payment model built on the existing claims system to address specific clinical conditions and patient-centered medical home facilities. The partnering firms are credited with developing and refining the episode model over nine months with “significant contributions and comment from hundreds of physicians, health care professionals, patients and other stockholders.”
Among the desired outcomes of the initiative is an increase in the number of Arkansans with health care coverage.
Independent reporting for Pine Bluff & Jefferson County since 1879.
The initial five episodes of care as part of the payment imitative are upper respiratory infection, total hip and knee replacements, congestive heart failure, attention deficit/hyperactivity disorder, and perinatal. The episodes will be “introduced” under the plan, with a preparatory period of three to six months. The period will give health care providers time to learn about the new model and, if necessary, to adjust their practices.
During the preparatory period, providers will receive detailed reports on “quality, care and utilization for their historical episodes.”
For each episode, all treating providers will continue to file claims as they’ve done previously and will be reimbursed according to each payer’s established fee schedule. The payer will identify a principal accountable provider for each episode, usually the provider with the “most influence and responsibility” over the episode. He or she will be ultimately responsible for ensuring a care episode is completed “at appropriate cost and sufficient quality” and “will share in savings or excess costs at the end of a one-year performance period,” an informational brochure states.
At the end of each performance period, the principal provider will be evaluated “across cost and quality metrics” for all of his or her completed episodes.
“By comparing each provider’s average costs for all completed episodes against each payer’s established cost thresholds, providers will be deemed eligible to share savings, will receive no additional payout, or will be responsible for sharing excess costs,” the brochure continues.
Attendees were assured early in the presentation that the initiative is not intended to “micro-manage” health care providers.
For more information, visit the web site www.paymentinitiative.org.