Arkansas doctors who take steps to coordinate patient care will continue to have a chance to receive extra payments from Medicare, Medicaid and private insurance companies under a new version of a federal program that will start next year, federal officials said Monday.
Arkansas is among 10 states and four other regions, including one that includes all of Ohio and part of Kentucky, that were selected to participate in the Comprehensive Primary Care Plus initiative, the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services announced.
Arkansas participated in a predecessor program -- Medicare's Comprehensive Primary Care Initiative, which began in 2012 and will end at the end of this year -- that included three other states and parts of three others.
Under the new program, Medicare, the federal insurance program for the elderly and disabled, will provide upfront payments to physician practices that agree to take steps such as making sure patients get preventive health screenings and providing around-the-clock access to a medical professional.
The practices will also receive upfront bonus payments for agreeing to meet certain performance standards but will be responsible for paying the money back if the standards aren't met.
The program also will offer a more rigorous track for practices that meet other requirements. Those practices will be eligible for additional upfront payments in exchange for a reduction in the amount they are paid for providing services.
In Arkansas, the state Medicaid program and insurance companies Arkansas Blue Cross and Blue Shield, Centene Corp., QualChoice Health Insurance as well as Arkansas Superior Select, which offers Medicare Advantage plans for Arkansans who are eligible for both Medicare and Medicaid, will also contribute payments to physicians.
Little Rock-based HealthScope Benefits, which administers insurance plans funded by employers, will also give its customers the option of participating, said Mike Castleberry, the company's senior vice president for network services and business development.
Castleberry called it a "no-brainer" for employers because the program will provide better health care services for their employees at a cost that is "pretty nominal."
"It's the right thing to do," he said.
The payments under the five-year pilot program will start Jan. 1.
The program was created by the Centers for Medicare and Medicaid Services' Innovation Center under the 2010 Patient Protection and Affordable Care Act.
Under the program it's replacing -- Comprehensive Primary Care Initiative -- 58 Arkansas physician practices serving an estimated 337,660 patients were enrolled as of June.
Arkansas also started a similar program, known as the state's patient-centered medical home initiative, in 2014 with help from a $42 million grant from the Innovation Center.
Payments under that program were going to 179 clinics on behalf of 330,000 Medicaid recipients as of January.
The upfront payments under the Comprehensive Primary Care Initiative, which totaled about $400,000 a year, have allowed SAMA Health-Care Services in El Dorado to "completely transform our clinic into a team-based system," clinic administrator Pete Atkinson said.
Each team, he said, is headed by a physician and includes a nurse who acts as a care coordinator, checking on patients after they are released from a hospital or referred to a specialist and making sure patients receive recommended screenings.
The clinic plans to apply to participate in the Comprehensive Primary Care Plus initiative, he said.
"We have confidence that we'll be successful" in meeting the new program's requirements, he said.
Each of the geographic areas that participated in the Comprehensive Primary Care Initiative was selected for the new version of the program.
In addition to Arkansas, that includes Colorado, New Jersey, Oregon, Tulsa and parts of New York, Ohio and Kentucky. The new version of the program expands to also include the rest of Oklahoma and Ohio as well as Hawaii, Michigan, Montana, Rhode Island, Tennessee, Philadelphia, and the Kansas City region in Kansas and Missouri.
Up to 5,000 practices in the 14 regions will be eligible for payments under the Comprehensive Primary Care Plus program compared with about 500 that received payments under the Comprehensive Primary Care Initiative.
In Arkansas, Blue Cross and QualChoice will contribute payments on behalf of customers enrolled in individual and employer plans, representatives of the companies said.
The program will also be an option for large employers that fund their own insurance plans, with Blue Cross or QualChoice administering the benefits.
"Overall care management is a good thing, and it helps control unnecessary medical" costs, QualChoice chief executive Michael Stock said.
Blue Cross customers that plan to participate include Wal-Mart, Baptist Health and the health plans covering state and public school employees, Blue Cross spokesman Max Greenwood said.
"Arkansas practices have been recognized nationwide for the great work that has taken place," Greenwood said in an email. "CPC Plus is an opportunity to continue this great work in Arkansas."
A Section on 08/02/2016