PCMHs, bundled payments, and Medicaid expansion are driving change and showing it is possible to transform a market on a wholesale basis, says one health insurance executive.
This article first appeared in the September 2016 issue of HealthLeaders magazine.
If you want to see what the healthcare industry landscape looks like after a statewide shift to value-based care models, look at Arkansas.
From the Mississippi Delta region in the east to the Ozark Mountains in the west, there are value-based reforms taking hold throughout the state's provider and payer markets. The patient-centered medical home has become the dominant primary care physician-practice business model; the top commercial payers and the state Medicaid program are jointly operating bundled payment reimbursement for nearly two dozen episodes of care; and private option Medicaid expansion through the Patient Protection and Affordable Care Act Health Insurance Exchange Marketplace has fueled the sharpest decline of uninsured patient rates in the country, with Gallup pollsters pegging the rate drop from 22.5% before Medicaid expansion in 2013 to 9.6% last year.
"What's different about the Arkansas market than just about anybody else you'll talk to is that the multipayer, public-private initiative did not start out as a voluntary or pilot effort. It was basically a mandatory, statewide approach that took the collaboration and consensus of multiple stakeholders to even have a chance. The story that could be learned from this marketplace is that it is possible to transform a market on a wholesale basis," says Steven Spaulding, senior vice president of enterprise networks at Little Rock–based Arkansas Blue Cross Blue Shield.
Christopher Cheney is the senior clinical care editor at HealthLeaders.