February 13, 2014 (DHS) - More than 40 percent of primary care providers will receive incentive payments for improving quality and efficiency within the state Medicaid program, the Department of Human Services said Wednesday.
Under the Arkansas Health Care Payment Improvement Initiative (AHCPII), providers are eligible to receive additional payments in exchange for taking steps to provide quality care while keeping costs low. Providers whose costs are not comparable to their peers may owe money to the Medicaid program.
Provider performance is measured in different episodes of care, which is the care a patient receives for a particular illness or disease from the time he or she is first diagnosed. For the first episode to wrap up its performance period, Upper Respiratory Infection (URI), 78 percent of providers will receive additional compensation or will be unaffected financially, while only 22 percent will owe money to the state, according to performance reports. The reports also reveal that providers are trending toward treatment that is more in line with best practices established by industry standards and local clinical advisors. The use of antibiotics to treat URIs fell more than 10 percent and the use of strep tests to diagnose pharyngitis rose more than 5 percent.
"While it is only our first episode, we are encouraged by the improvements providers have made in the care and treatment of URI," said Dawn Zekis, Director of Health Care Innovation with Medicaid. "It signifies an important first step in moving away from the existing system based primarily on payment to one that rewards providers for quality and efficiency. That is one of the primary goals of the Payment Improvement Initiative."
AHCPII is a multi-payer initiative including Medicaid, Arkansas Blue Cross and Blue Shield, and QualChoice of Arkansas. There are currently 15 episodes of care in existence or scheduled for roll out. The outcomes for the first performance period for Perinatal and Attention Deficit/Hyperactivity Disorder are due to be announced in May. Information about the other episodes is available on the AHCPII website, www.paymentinitiative.org.