HJLR Nov/Dec 2018

Healthcare Journal of LITTLE ROCK I  NOV / DEC 2018 49 WilliamGolden, MD Arkansas Medicaid Medical Director As a result, after consultation with PCMH participants and DHS leadership, Medicaid will make significant changes to the PCMH incentive program for 2019. Enrolled PCMH sites will still be expected to meet specified activity requirements such as care plans for high-risk patients to qualify for per mem- ber per month practice support. Passing a basket of quality metrics to qualify for fi- nancial incentive bonuses will also remain a core feature of the program. Performance based incentive payments (PBIP) will now focus on surrogate measures of total cost of care including risk adjusted admission rates and emergency room utilization by a prac- tice’s patient panel. In addition, there will be a focus quality measure—wellness visit rates for adolescents—for which high performing practices will receive incentive payments. Total incentive money available will be equal to, if not greater than, past payments to high performing participants. Moreover, practices can receive incentives for achievement on each of three measures and not just a single total cost of care calculation. Highest per- forming practices will get the greatest re- wards with a tiered bonus structure for prac- tices in the upper 35 percent of achievement of each designated metric. This new format also reduces actuari- al complexity of the program. In the past, PCMH required a practice or a pool of clinics to maintain a panel of at least 5,000 patients to assure statistical validity of total cost of care calculations. The change to the new in- centive metrics will allow practices sites to qualify for these payments with only 1,000 patients on a panel. In addition, Medicaid has lowered the minimum panel size for a prac- tice to participate in the program from 300 patients to 150. Small practices have options regarding how to participate in the incentive program (for details see www.paymentini- tiative.org ) Coupled with this new direction, Arkan- sas Medicaid, in collaboration with General Dynamics Health Solutions, will provide monthly spreadsheets to each practice site on the PCMH portal. Like Blue Cross Blue Shield of Arkansas, Medicaid is committed to providing the timeliest, most accurate feedback data to practices to allow them to target gaps in care andmaximize the popula- tion health statistics of their patient panels. The successful implementation of the new Medicaid Management Information System (MMIS) facilitates more timely and flexible data analysis to support the PCMH program. The Medicaid PCMH program continues to evolve in partnership with commercial payers in the state. The support and engage- ment by the provider community has been a major strength of effort. In the future, it is hoped that a stronger health information exchange (HIE) capacity will facilitate reliable clinical information from electronic medi- cal records to produce even more robust, timely information to practice sites. As we enter 2019, PCMH has become a sustaining force for Arkansas primary care and better health experiences for the patients in our communities. n “Medicaid is committed to providing the timeliest, most accurate feedback data to practices to allow them to target gaps in care and max- imize the population health statistics of their patient panels.”