Arkansas – Medical Homes

Arkansas Health Care Payment Improvement Initiative

In early 2011, Arkansas’s Department of Human Services proposed an initiative they call “Transforming Arkansas Medicaid” (in later documents, “Transforming Arkansas Health Care”).  The Arkansas Department of Human Services (which oversees Arkansas Medicaid) has partnered with two large private insurers in the state, Arkansas Blue Cross and Blue Shield and Arkansas QualChoice, to implement this broad payment and delivery system reform initiative.

The alliance, known as the Arkansas Health Care Payment Improvement Initiative, introduced the first phase of reform in October 2012. This model attempts to move away from fee-for-service payments and towards a system that rewards value and outcomes by instituting a shared-savings/shared-risk model based on providers’ average costs for selected episodes of care. To learn more about Arkansas’s Payment Improvement Initiative, visit the Arkansas page on NASHP’s Accountable Care Activity Map.

Arkansas envisions medical homes as a key component of a transformed health care system. Currently, the state is implementing medical homes through CMS’s Comprehensive Primary Care Initiative (CPCi). In the future, the state envisions a voluntary program for interested practices, with plans to grow to include most, if not all, practices in the state.

In April 2013, Arkansas enacted the Health Care Independence Act of 2013, requiring insurers offering plans in the state’s health insurance marketplace to participate in the Health Care Payment Improvement Initiative by supporting medical homes and sharing clinical data with providers.

Federal Support: 

  • Arkansas is one of six states selected in February 2013 by the Centers for Medicare and Medicaid Innovation (CMMI) to receive a State Innovation Model (SIM) Model Testing Award. Arkansas received $42 million to implement and test its State Health Care Innovation Plan, which builds on the state’s Health Care Payment Improvement Initiative and emphasizes development of medical homes and health homes in the state.
  • Arkansas is one of seven markets participating in CMS’s Comprehensive Primary Care Initiative (CPCi). In this multi-payer initiative, Medicare is collaborating with public and private insurers in the selected states and regions with the goal of strengthening primary care. In Arkansas, CPCi launched in October 2012, bringing together four payers, as well as 69 participating primary care practices with 275 providers across the state.
  • Arkansas has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions. For more information on the Arkansas’s application, visit the state’s archive for their health homes planning initiative. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.

Last Updated: April 2014

Forming Partnerships
Arkansas Health Care Payment Improvement Initiative: Arkansas has received input on their payment and delivery system transformation initiative from Arkansans via meetings with key stakeholders, workgroups, webinars and town hall meetings. Project staff have met with a wide range of stakeholders, including:
  • Consumers and consumer advocacy organizations;
  • Providers and statewide provider associations;
  • Provider office staff; and
  • State policymakers.
The state Department of Human Services partnered with Arkansas Medicaid and two large private payers, Arkansas Blue Cross and Blue Shield and Arkansas QualChoice, to form the Arkansas Care Payment Improvement Initiative. This group worked with providers, health administrators, patients and advocacy groups to design the initiative.
For more information, visit the state’s archive for this initiative.
Defining & Recognizing a Medical Home
Arkansas Health Care Payment Improvement Initiative: The Payment Improvement Initiative defines medical homes as “a doctor or care team that takes responsibility for the overall health of a patient.”
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commission, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
  • Health information technology, including attestation to Stage 1 Meaningful Use and engagement with local Regional Extenson Center (REC);
  • Percentage of practice revenue earned from participating payers; and
  • Participation in practice transformation programs through organizations like quality improvement organizations, RECs, or learning collaboratives.
Aligning Reimbursement & Purchasing
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in October 2012, includes five payers in the Arkansas market: Medicare, Arkansas Medicaid, Arkansas Blue Cross and Blue Shield, Humana, and Qual Choice of Arkansas.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.