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.
In performance-based clinics, doctors receive a portion of their payment based on the quality of care.
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.
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 14 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.
Through the Arkansas Healthcare Payment Improvement Initiative (AHCPII), Arkansas Blue Cross and Blue Shield has joined with other payers, Arkansas Medicaid and the Arkansas Department of Human Services to reward care coordination, quality and efficiency. An episode of care is focused on all the care provided to treat a single condition for a given length of time.
Let's say you need a knee replacement. In the episode-based payment model, a doctor is designated as the principal accountable provider (PAP) for the knee replacement. The PAP is responsible for ensuring that all other medical professionals and facilities provide efficient, quality care to you related to the knee replacement. Doctors and hospitals share in the savings, or excess costs, of the knee replacement, depending on their performance.
Does it work? We have proven results! When reviewing the episodes of care for knee and hip replacements from 2013 through 2015, here is what we found:
Learn more about AHCPII
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.
Arkansas Blue Cross collaborates with primary care physicians within a CHI to jointly manage the quality and efficiency of your care. Arkansas Blue Cross 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 Arkansas Blue Cross work to meet quality and financial targets.
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.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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