Value-Based Care

Value-based care focuses on getting value from quality services. It is a shift from fee-for-service, or volume-based care. With value-based care, payments to doctors and hospitals are partially based on keeping people healthy, rather than simply the number of tests or services performed. Providers are rewarded for coordinating care, providing appropriate care, preventive services, and for positive health outcomes.

The following programs are available to health care providers and/or hospitals in the Arkansas Blue Cross networks.

Performance-based programs (PCF, PCMH)

• Benefits of Participation [pdf]
• Eligibility Requirements [pdf]
• Program Comparison [pdf]
• Primary Care Representative Contacts [pdf]

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's 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 began January 2021.

Patient-Centered Medical Home (PCMH)

The patient-centered medical home (PCMH) model is a method to deliver and organize healthcare that helps to improve the patient's experience of care, improve the health of populations, and reduce or control the costs of healthcare. The PCMH model allows the primary care provider and the patient to be in the center of the healthcare system, to know what is going on and help the patient be in control of their health.

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.

Arkansas Blue Cross collaborates with primary care physicians within a CHI to jointly manage the quality and efficiency of care. Through this collaboration, the CHIs and Arkansas Blue Cross work together to meet quality and financial targets.