More clinics signing up to be paid by Medicaid

More than 100 additional Arkansas clinics have signed up to be paid by the state’s Medicaid program to better coordinate patient care, raising the total number of clinics receiving such payments to 179, according to the state Department of Human Services.

Under the state’s patient-centered medical home initiative, clinics receive quarterly payments in exchange for taking such steps as making sure patients get preventive health screens, coordinating care among providers and providing around-the-clock access to a medical professional.

The initiative began in the fall of 2012, when dozens of clinics began receiving payments from Medicare, Medicaid and private insurance companies under a program created as a result of the 2010 federal health-care-overhaul law.

In October of last year, the Human Services Department began enrolling additional clinics in a similar, Medicaid-funded program.

During the enrollment period that ended Dec. 15, 111 clinics signed up, department spokesman Amy Webb said.

The clinics enrolled in the two programs serve about 243,000 Medicaid recipients, more than 40 percent of those enrolled in the traditional fee-for-service Medicaid program.

The Medicaid program is making quarterly payments to the clinics that recently signed up equal to an average of $4 per patient per month, with higher payments for patients who are older or have a history of medical problems and lower payments for younger, healthier patients.

The fiscal first-quarter payments to the clinics totaled more than $2.7 million, Human Services Department spokesman Kate Luck said. State tax dollars provide 30 percent of the cost for the payments, and the federal government contributes the rest.

Next year, clinics that keep their patients’ overall health-care costs low also will be eligible for additional payments, representing a portion of the money saved by the state’s Medicaid program because of the reduced medical bills.

The most recent clinics to sign up include six of the University of Arkansas for Medical Sciences’ primary-care clinics, said Mark Mengel, the university’s vice chancellor for regional programs.

Five other UAMS clinics already were enrolled in the earlier phase of the initiative.

All 11 clinics already have made changes to better manage the care of patients with chronic diseases, such as heart disease and diabetes, Mengel said.

About half of the clinics’ 80,000 patients are on Medicaid, he said.

“We’re pretty heavily invested in the patient-centered medical home, not only because we feel it’s a better model of care for our patients, but because we have to train the next generation of primary care doctors,” Mengel said.

Last month, the Human Services Department began enrolling a third group of clinics that will begin receiving payments on July 1. That enrollment period ends May 15.

CURBING GROWTH

State officials hope the initiative will curb the growth of spending in the state’s Medicaid program, which is expected to total about $5.2 billion during the fiscal year that ends June 30, with the federal government providing more than 70 percent of the funding.

Another program assigns bonuses or penalties for doctors according to their average cost for providing certain “episodes of care,” such as treating an upper respiratory infection or delivering a baby.

The Human Services Department gave doctors information last week about the first bonuses awarded and penalties assessed under that program, Luck said. She didn’t have further details, she said, because the department was still compiling data last week.

The medical-home initiative began in October 2012, when more than 60 practices in Arkansas began receiving quarterly payments under a pilot project known as the federal Comprehensive Primary Care Initiative.

According to the Centers for Medicare and Medicaid Services, the federal government’s payments to the clinics under that program have totaled $19.7 million on behalf of Arkansans enrolled in Medicare, and $2.6 million on behalf of Medicaid recipients.

Arkansas Blue Cross and Blue Shield; QualChoice Health Insurance; Humana, the state insurance plans for teachers and state employees; and TRICARE, the health insurance program for current and former members of the military, also are contributing payments, Webb said.

Wal-Mart Stores also is contributing payments on behalf of Arkansas employees covered by its health plan, she said.

But so far, the state Medicaid program is the only entity making payments to the 111 clinics that signed up under the latest phase of the initiative.

Webb said “there is active discussion” about expanding the participation of the insurance companies and others to include those clinics.

Next year, participation will be required by insurance companies on behalf of customers who sign up for plans offered through the state’s health insurance exchange.

As of early last week, those signed up for the plans included more than 83,000 adults with incomes below 138 percent of the poverty level whose premiums are being paid with federal Medicaid dollars under the so-called private option approved by the state Legislature last year. More than 16,000 others who did not qualify for Medicaid had also signed up for the exchange plans as of Jan. 26.

The Legislature will decide during the fiscal session that starts Monday whether to authorize funding for the private option for the fiscal year that starts July 1.

STEPS TAKEN

UAMS family clinics in Fayetteville, Springdale, Fort Smith, Texarkana and Jonesboro received an average of about $500,000 each in total payments under the Comprehensive Primary Care Initiative last year, Mengel said.

By contrast, this year’s payments for each of the clinics that signed up for the Medicaid program begun last month are expected to average $150,000 to $200,000, he said.

The clinics that recently joined the Medicaid payment program include the university’s four other family medical center clinics, located in Pine Bluff (which has two clinics), Magnolia and Little Rock. The university’s two internal medicine clinics in Little Rock also signed up, he said.

Over the past three years, the clinics have spent about $6 million to better coordinate patient care, hiring dozens of additional staff members and spending hundreds of thousands of dollars at each family clinic on software and other technical upgrades to accommodate a greater use of electronic medical records.

Each clinic has identified its high-risk patients. Doctors and nurses at the clinics work in teams to track patients’ health status, and a computerized “disease registry” helps them monitor patients with chronic conditions.

The clinics also installed a system that allows patients to use a secure online portal to receive messages from their doctors, access their own laboratory test results and request appointments and prescriptions.

The efforts appear to be yielding results, with the clinics noting improvements in measures such as the percentage of diabetics controlling their blood sugar levels, getting timely exams and receiving vaccinations, Mengel said.

“That’s all been good news for us,” he said.

He said he hopes the clinics will reap additional payments from Medicaid next year for reducing patients’ health-care costs. But to qualify for those “shared savings,” clinics must first meet several quality measures, which Mengel called “pretty aggressive.”

The Arkansas Medical Society supports the patient-centered medical home initiative but wants insurance companies and Medicare to join the Medicaid program in contributing payments to more of the clinics, said David Wroten, the association’s executive vice president.

“It doesn’t work for part of a physician’s practice to be organized around a patient-centered medical home and the rest of a physician’s practice not to be,” Wroten said.

Medicaid is “a catalyst for getting this thing going,” he said, but “we really won’t see the full impact of the patient-centered medical home concept unless all payers are participating.”