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Value-based care programs

Your health, financial security and peace of mind are important to us. That's why we've been working with doctors, hospitals, and state and federal government organizations to develop value-based care programs in Arkansas.

Traditionally, when you go to the doctor, a set price is paid for the services your doctor provides. The more tests and services you get, the more the doctor or hospital is paid. This is called the fee-for-service payment model. This healthcare payment model doesn't factor in the quality of your care or whether you get better.

With value-based care, payments to doctors and hospitals are partially based on keeping people healthy, rather than the number of tests or services performed. It rewards physicians for coordinating care, providing appropriate care and for positive health outcomes.

We are involved in two types of value-based care models:

  1. Performance-based programs
    • Patient-Centered Medical Homes (PCMH)
    • Comprehensive Primary Care initiative (CPC, CPC+)
  2. Collaborative Health Initiatives (CHI)

Performance-based programs (PCMH and CPC+)

In performance-based clinics, doctors receive a portion of their payment based on the quality of care.

Patient-centered medical homes (PCMH)

These are clinics with medical teams that build relationships with patients and help coordinate their care with other medical services outside the clinic, including other resources within the community.

Most of these clinics offer:

  • 24/7 nurse help line
  • Priority appointment scheduling for high-risk patients
  • Same-day appointment slots for urgent care planned into the appointment schedule
  • Short wait times for appointments, and appointments with nurse practitioners and other medical personnel to keep the schedule moving
  • Email and websites for electronic communication
  • Surveys to improve the consumer experience
  • Access to an online care management portal
  • Focus on gaps in care, like preventive screenings
  • Care plans that track the clinic’s and patient’s health goals
  • Focus on health literacy and patient comprehension

The Comprehensive Primary Care Plus (CPC+) initiative

Through the Centers for Medicare and Medicaid Services (CMS), CPC+ supports 182 primary care practices in the state as they change the way they provide care. The state of Arkansas is one of 18 regions nationwide to participate in CPC+. The original CPC initiative lasted four years, included 69 clinics and brought more than $50 million to the state. Support for the initiative is provided by CMS, health insurance companies and state Medicaid agencies. Learn more about the CPC+ program.

Collaborative Health Initiatives (CHIs)

CHIs are groups of doctors, hospitals and other healthcare professionals that come together to provide coordinated high-quality care. They are similar to accountable care organizations.

Health Advantage collaborates with primary care physicians within a CHI to jointly manage the quality and efficiency of your care. Health Advantage produces monthly reports with high-level information to help with the overall management of the CHI as well as detailed reports to your doctor to support your care. Through this collaboration, the CHIs and Health Advantage work to meet quality and financial targets.

How does this affect you?

Much of the inner-workings of value-based care go on behind the scenes, but the results can have a positive impact on the care you receive. You can find doctors and hospitals participating in some of these programs through our Find A Doctor or Hospital tool.