PCMH adoption has been building steadily in the state since 2010, with Arkansas BCBS launching PCMH contracting in 2010, the Centers for Medicare & Medicaid starting the Comprehensive Primary Care (CPC) Initiative in 2012—a multipayer program created to strengthen primary care that offers population-based care management fees and shared savings opportunities to primary care practices that participate, with the goal of improving care, achieving better health for populations, and lowering costs—and state lawmakers requiring all HIX-qualified health plans to participate in Medicaid's PCMH program.
Approaching population health with an emphasis on primary care is essential for PCMH success, says Alicia Berkemeyer, vice president of the enterprise primary care and pharmacy programs at Arkansas BCBS. "When we were trying to attribute members to a provider, we were quite surprised that many of our members had not seen a primary care doctor in two, three, four years. So because of our commitment to primary care and the belief in having a relationship with a primary care doctor, we spent an entire year going through our membership and educating them on the importance of primary care and having a primary care provider. If they did not choose a primary care provider in a 35-day period, we sent a second letter recommending one in their area to align them with, because if we want to get providers to manage a population, we have to identify the population they need to manage."
Another ingredient for PCMH success is financial support in the form of PMPM payments, with CPC PMPM Medicare payments in Arkansas averaging $20, Medicaid PMPM payments as high as $8, and commercial PMPM payments for Medicaid expansion patients set at a minimum of $5.
Getting up-front PMPM payments is crucial, Berkemeyer says. "That's the tool they needed to make this transformation. This is not an easy task for these providers. One of the key things that started early with the CPC money and the PMPM with the multipayers was that it enabled many of them to support care managers in their practices, and for care coordination and care management to be active and be proactive in closing gaps in care, getting the members in, making sure they're on their appropriate medication and that medication is reconciled. You could talk with any of the practices out there today with the CPC and the state PCMH—we have about 210—and they would say without that PMPM, they could not do the work that they are doing today."
Christopher Cheney is the senior clinical care editor at HealthLeaders.