Principal Accountable Provider Health Care Payment Improvement by alicejenny


									Principal Accountable Provider
                        Arkansas Health Care Payment Improvement Initiative

           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, though the data             initiative, visit www.
system. The goal is to reward providers who       will not be tied to payment during this time.
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 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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