Principal Accountable Provider PAP Arkansas Health Care Payment Improvement Initiative T he Arkansas Health Care Payment preparatory period beginning July 1, Improvement Initiative is part of a providers may report a limited set of clinical For the latest multi-payer effort to transform the metrics through the Provider Portal at www. information on the state’s health care and payment paymentinitiative.org, though the data initiative, visit www. system. The goal is to reward providers who will not be tied to payment during this time. paymentinitiative.org. deliver high-quality, coordinated, and cost- Medicaid and private payers will use these effective care for certain clinical episodes. clinical metrics to track and monitor the content and quality of care for each episode. The first phase focuses on these episodes: PAPs’ average cost across all of their episodes perinatal care, attention deficit/hyperactivity will then be compared to the payers’ cost disorder (ADHD), upper respiratory thresholds to determine whether the PAP infection (URI), hip and knee replacement, is eligible to share savings, will receive no and congestive heart failure (CHF). additional payout, or will be responsible for sharing excess costs. What is a PAP? How do PAPs submit data and view For each episode of care, payers will use reports? claims data to determine which physician practice, hospital or other provider is most Physician practices, hospitals, Rehabilitative responsible and accountable for the quality Services for Persons with Mental Illness and cost of care. This “quarterback” of providers, and other qualifying providers care, called the Principal Accountable may log into the Provider Portal at www. Provider (PAP), leads and coordinates the paymentinitiative.org. Providers will submit episode’s team of providers and helps drive several pieces of quality data for the ADHD, improvement. Only PAPs are eligible to CHF, and hip and knee episodes. Providers share in savings or excess costs of episodes will also receive periodic reports through based on the average quality and cost of care the portal detailing their quality, cost, and over all episodes for a given time period. utilization. How are PAPs and other providers paid? When do these changes begin? Providers will submit claims to payers as PAPs may begin reporting on the ADHD, they do now and will continue to receive CHF, and hip and knee episodes July 1. reimbursement based on existing fee Reports based on historical data will be AFMC has partnered with the initiative to provide communication schedules. During a three- to six-month available for some episodes by the end of July. design and printing.
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