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)
• Primary Care First (PCF)
  
2. Collaborative Health Initiatives

Performance-based programs (PCMH and PCF)

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

Primary Care First (PCF)

Primary Care First (PCF) is a national advanced alternative payment model that aims to strengthen primary care through regionally based multi-payer payment reform and care delivery transformation. PCF aims to improve quality, improve patient experience of care, and reduce expenditures.

Arkansas Blue Cross partners with CMS in this five-year national model to strengthen primary care in Arkansas. Primary Care First seeks to improve quality, access, and efficiency of primary care. PCF in Arkansas begins January 2021.

Primary First Payment Model Options

Collaborative Health Initiatives

Collaborative Health Initiatives 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 Collaborative Health Initiative 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 Collaborative Health Initiative as well as detailed reports to your doctor to support your care. Through this collaboration, the Collaborative Health Initiatives 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.