Episode-based care delivery

1. The shift to paying for results is just one part of a broader program to improve the way that care is delivered in Arkansas Objectives • Improve the health of the population • Enhance the patient experience of care • Enable and encourage patients to take a more active and informed role in their own care • Reward providers for high quality, efficient care • Reduce or control the cost of care For patients For providers How care is delivered Medical homes + Health homes Episode-based care delivery Four aspects of broader program • Results-based payment and reporting • Health care workforce development • Health information technology (HIT) adoption • Expanded access for health care services

2. The goal How it works Incentive The Arkansas approach is designed to reward coordinated, team-based care across the whole person and for specific conditions or procedures How we are implementing it… Medical homes andHealth homes Episode-based care delivery Our overall approach • Providers proactively work as a team to manage a patient’s overall health • Patient journey: all healthcare and support services needed by a patient over time • Patient journey: all services related to a specific condition, procedure, or disability • Typically one provider is designated as ‘quarterback’ for all patient needs for a period of time • Quarterback: the provider in best position to influence prevention and management of chronic disease • Quarterback: ‘Principal Accountable Provider’ in best position to influence cost and quality of services for the episode • Providers are rewarded for providing high-quality care at an appropriate cost • Outcome measured includes overall health of the provider’s patient population (across all conditions and episodes) • Outcome measured is average cost and quality of care for all patients that experience a given ‘episode’ (e.g., a surgery)

3. Two types of episode-based care delivery Likely model for most CFCO services Assessment-based episodes • Clinical guidelines are clear and predict the level of need • Diagnosis is concrete and reliable • Trajectory of the episode is consistent across clients • Condition is of a meaningful size • Diagnosis is “separable” from (not consistently associated with) other conditions • A reliable assessment that accurately predicts need exists • Trajectory should be consistent with assessment results for a defined period of time • The assessment covers a majority of the client’s needs in that area Criteria • Guidelines-based episodes • Acute medical episodes, e.g., URI, pregnancy • Some behavioral health conditions, e.g., ADHD • Support services driven by level of functional need, e.g., developmental disabilities, LTSS Examples

4. Process flow for needs-based episode PRELIMINARY Universal assessment determines episode amount Performance transparency helps clients select provider Integrated person-centered care plan written Provider score card Saline county 2011 episode score 2011 health home score Provider A A Provider 1 B A Provider 2 C B Provider 3 Services begin Provider submits encounter data and receives payment Provider receives periodic report to track amount Last year budget: $25k Budget $20k $10k $30k Actual $18k Recipient: John Smith