Two Arkansas health-care provider networks will begin participating in a program next week in which they will be able to earn rewards for lowering the cost of providing care to patients covered by Medicare, a federal agency announced this week.
The Arkansas Health Network, owned by the St. Vincent Health System, and Arkansas Accountable Care LLC, formed by the Medical Associates of Northwest Arkansas, will join hundreds of so-called accountable-care organizations participating in the Medicare program, which was created as part of the 2010 federal health-care overhaul law.
Another Arkansas-based provider network, the Fort Smith Physicians Alliance, began participating in the program at the beginning of this year.
Nationally, the Medicare Shared Savings Program includes more than 360 provider organizations serving 5.3 million Medicare patients, according to the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services.
The Arkansas Health Network and Arkansas Accountable Care LLC are among 123 organizations that will join the program starting Wednesday.
Participating organizations must serve at least 5,000 Medicare patients and must eventually meet 33 quality measures for providing patient care. Those that reduce the cost of their Medicare patients’ medical services below a certain threshold will receive payments equal to a percentage of the savings to the federal government.
As part of their agreement with the Medicare agency, the organizations can also opt to be responsible for some of the excess cost if the patients’ care exceeds the acceptable range. Organizations that accept that risk are eligible for a greater percentage of “shared savings” if the costs are below the acceptable range.
The Arkansas Health Network includes the St. Vincent Health System’s hospitals in Little Rock, Sherwood and Morrilton as well as about 380 doctors.
About 120 of the doctors are employed by the health system, and 260 are independent, said Jon Timmis, president of the Arkansas Health Network and St. Vincent’s chief strategy officer.
The network’s more than 10,000 Medicare patients will receive notices allowing them to opt out of the program, Timmis said.
For those who choose to participate, the organization will identify patients with the greatest needs and assign “health coaches” to help some patients navigate the health-care system and keep up with their medications.
“It puts them into a more disciplined and rigorous care management model,” Timmis said.
Patients participating in the program are not restricted to seeing providers within the network, Timmis said.
He said the network will receive half of any savings generated above a certain threshold but will not be responsible for making payments if the costs are higher than expected.
The health system formed the organization in March. Most of St. Vincent’s 50 or so primary-care physicians will also participate next year in a similar Medicaid-led program that will reward doctors for keeping Medicaid patients’ health-care costs low, Timmis said.
“As health care changes from being fee-for-service based to being value-based, we knew that we were going to have to transform the way in which we provide care from being traditionally episodic to being more population-based, so more aggressively managing folks when they’re not actively seeking care,” Timmis said.
The network also formed an agreement to provide care to patients who sign up for in certain QualChoice Health Insurance plans offered on the state’s health insurance exchange, which was also established under the 2010 Patient Protection and Affordable Care Act.
In response to an inquiry by the Arkansas Medical Society, which represents physicians, Arkansas Insurance Commissioner Jay Bradford is reviewing whether QualChoice’s agreements with the Arkansas Health Network, as well as Northwest Arkansas-based Health Partners, conforms with the state’s “any willing provider” law.
That law requires insurance companies to include in their networks any hospital, doctor or other health-care provider who meets the conditions set by the insurance company.
Like the Arkansas Health Network, Medical Associates of Northwest Arkansas’ accountable-care organization, which includes 70 physicians, will be eligible for shared savings from Medicare, but won’t be responsible for reimbursing Medicare if the costs are higher than expected, Chief Executive Officer Jason Wilson said in an email.
David Wroten, executive vice president of the Medical Society, said his group doesn’t have a position on the shared savings program.
“Our issue is always going to be, does it provide patients with their choice of physicians,” Wroten said.
Arkansas, Pages 9 on 12/27/2013