New health care payment plan for Arkansas

    9:50 PM, Jun 28, 2012   |    comments
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    LITTLE ROCK, Ark. (KTHV) -- Health care made nationally Thursday but also here in Arkansas as we're learning more about a ground-breaking health care payment program rolling out next week in the Natural State.

    It hopes to provide better care and control costs for patients on both public and private insurance coverage.

    What's coming here is the first of its kind for the country as far as a state-wide healthcare program and both the public and private sectors getting involved.

    On Thursday afternoon, a panel spoke about Phase One of the "Health Care Payment Improvement Initiative." The major players so far are the Department of Human Services, which runs Arkansas' Medicaid program, Blue Cross Blue Shield of Arkansas and QualChoice Arkansas. For some perspective, we're told Medicaid and Blue Cross combined serve about two-thirds of the Arkansas insurance market.

    Starting Monday, July 2, the program begins with five specific medical situations. They are: Hip and knee replacement, pregnancies, routine colds, sore throats and sinus issues wrapped into one, heart failure and Attention Deficit Hyperactivity Disorder.  

    So how does it work? Well let's take a hip or knee replacement case. Under the old way, a fee for service model, you pay a fee to your doctor, to the surgeon, to the hospital, to the physical therapist; you're basically piled up with individual fees there and paying as you go. 

    Under the new way, it's a value, out-come based approach. It's basically a package deal with a leading provider coordinating all of your care and getting one overall payment that is driven by performance.

    "We really want to pay more for outcomes and results and say if you get a good quality outcome at a good reasonable price, we'll pay you for that and if in fact you're able to do it well, we will share some of the savings with you," said John Selig, Director of the Department of Human Services.

    Selig says, getting into the actual cost structure, collaboration with industry experts, Arkansas doctors and the State Medical Society helped determine the typical amount a patient ought to pay for the conditions in Phase One of this program. It wil; give those doctors savings charging below the average and penalties for charging above. We spoke with a UAMS doctor who was part of Thursday's panel and here's what he had to say about his colleagues feelings right now.

    "They are a little nervous but they realize that something has to change and when they get the feel of it, they see that it's a reasonable approach and they're having efforts to have feedback so we can make adjustments as needed," Dr. William Golden said.

    This new program is a year in the making and also included feedback from patients. The road ahead includes a series of town hall meetings this summer state-wide to educate the public and doctors who may still need a briefing. For more information on the program, just click here.

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