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The shift to paying for results is just one part of a broader program to improve the way that care is delivered in Arkansas. Objectives. Improve the health of the population Enhance the patient experience of care

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The shift to paying for results is just one part of a broader program to improve the way that care is delivered in Arkansas

Objectives

  • Improve the health of the population

  • Enhance the patient experience of care

  • Enable and encourage patients to take a more active and informed role in their own care

  • Reward providers for high quality, efficient care

  • Reduce or control the cost of care

For patients

For providers

How care is delivered

Medical homes + Health homes

Episode-based care delivery

Four aspects of broader program

  • Results-based payment and reporting

  • Health care workforce development

  • Health information technology (HIT) adoption

  • Expanded access for health care services


The goal broader program to improve the way that care is delivered in Arkansas

How it works

Incentive

The Arkansas approach is designed to reward coordinated, team-based care across the whole person and for specific conditions or procedures

How we are implementing it…

Medical homes andHealth homes

Episode-based care delivery

Our overall approach

  • Providers proactively work as a team to manage a patient’s overall health

  • Patient journey: all healthcare and support services needed by a patient over time

  • Patient journey: all services related to a specific condition, procedure, or disability

  • Typically one provider is designated as ‘quarterback’ for all patient needs for a period of time

  • Quarterback: the provider in best position to influence prevention and management of chronic disease

  • Quarterback: ‘Principal Accountable Provider’ in best position to influence cost and quality of services for the episode

  • Providers are rewarded for providing high-quality care at an appropriate cost

  • Outcome measured includes overall health of the provider’s patient population (across all conditions and episodes)

  • Outcome measured is average cost and quality of care for all patients that experience a given ‘episode’ (e.g., a surgery)


Two types of episode based care delivery
Two types of episode-based care delivery broader program to improve the way that care is delivered in Arkansas

Likely model for most CFCO services

Assessment-based episodes

  • Clinical guidelines are clear and predict the level of need

  • Diagnosis is concrete and reliable

  • Trajectory of the episode is consistent across clients

  • Condition is of a meaningful size

  • Diagnosis is “separable” from (not consistently associated with) other conditions

  • A reliable assessment that accurately predicts need exists

  • Trajectory should be consistent with assessment results for a defined period of time

  • The assessment covers a majority of the client’s needs in that area

Criteria

  • Guidelines-based episodes

  • Acute medical episodes, e.g., URI, pregnancy

  • Some behavioral health conditions, e.g., ADHD

  • Support services driven by level of functional need, e.g., developmental disabilities, LTSS

Examples


Process flow for needs based episode
Process flow for needs-based episode broader program to improve the way that care is delivered in Arkansas

PRELIMINARY

Universal assessment determines episode amount

Performance transparency helps clients select provider

Integrated person-centered care plan written

Provider score card

Saline county

2011 episode score

2011

health home score

Provider

A

A

Provider 1

B

A

Provider 2

C

B

Provider 3

Services begin

Provider submits encounter data and receives payment

Provider receives periodic report to track amount

Last year budget: $25k

Budget

$20k

$10k

$30k

Actual

$18k

Recipient: John Smith


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