[Vision2020] The Arkansas Innovation

[lfalen]

At least they are trying something other than throwing more money at the problem.
Roger
-----Original message-----
From: Art Deco art.deco.studios at gmail.com
Date: Thu, 06 Sep 2012 03:58:19 -0700
To: vision2020 at moscow.com
Subject: [Vision2020] The Arkansas Innovation

> [image: Opinionator - A Gathering of Opinion From Around the
> Web]<http://opinionator.blogs.nytimes.com/>
> September 5, 2012, 9:17 pmThe Arkansas InnovationBy EZEKIEL J.
> EMANUEL<http://opinionator.blogs.nytimes.com/author/ezekiel-j-emanuel/>
> 
> Philadelphia
> 
> MENTION medical innovation, and you might think of the biotech corridor
> around Boston, or the profusion of companies developing wireless medical
> technologies in San Diego. But one of the most important hotbeds of new
> approaches to medicine is ... you didn't guess it: Arkansas.
> 
> The state has a vision for changing the way Arkansans pay for health care.
> It is moving toward ending "fee-for-service" payments, in which each
> procedure a patient undergoes for a single medical condition is billed
> separately. Instead, the costs of all the hospitalizations, office visits,
> tests and treatments will be rolled into one "episode-based" or "bundled"
> payment. "In three to five years," John M. Selig, the head of Arkansas's
> Department of Human Services, told me, "we aspire to have 90 to 95 percent
> of all our medical expenditures off fee-for-service."
> 
> The change will encourage doctors and hospitals to work together to provide
> patients with the highest quality care, while at the same time lowering
> costs by eliminating unnecessary tests and treatments. It has been done
> before, in small-scale experimental pilot programs. But as the Arkansas
> officials make clear, this change will now be made in every corner of the
> state, for every hospital, and physicians in almost every specialty:
> surgeons, anesthesiologists, obstetricians, pediatricians, primary care
> physicians. For policy makers and the public, the Arkansas experiment is
> fascinating.
> 
> This is how it will work: Medicaid and private insurers will identify the
> doctor or hospital who is primarily responsible for the patient's care -
> the "quarterback," as Andrew Allison, the state's Medicaid director, put
> it. The quarterback will be reimbursed for the total cost of an episode of
> care - a hip or knee replacement; treatment for an upper respiratory
> infection or congestive heart failure; or perinatal care (the baby's
> delivery, as well as some care before and after).
> 
> The quarterbacks will also be responsible for the cost and quality of the
> services provided to their patients, and will receive quarterly reports on
> those metrics from the state (for Medicaid patients) or private insurers.
> If they have delivered good care based on agreed-upon standards, and if
> their billings come in lower than the agreed-upon level, they can keep a
> portion of the difference. If their billings come in above an acceptable
> level - usually because they have ordered too many unnecessary tests,
> office visits or inappropriate treatments - they will have to pay money
> back to the state or insurer.
> 
> Arkansas may seem an odd place for such a bold experiment. It has the
> sixth-highest poverty rate in the country, and ranks near the bottom in
> everything from the percentage of pregnant women getting prenatal care and
> the infant mortality rate to obesity, diabetes and life expectancy. It
> doesn't have enough doctors; all but two of the state's counties are
> designated as either entirely or partially medically underserved. And until
> recently, it was way behind on the adoption of electronic health records.
> 
> Yet Arkansas also has certain advantages. It has a governor who understands
> the issues very well. And it has doctors and hospitals who - faced with a
> State Legislature resistant to raising taxes, an imminent shortfall in
> state Medicaid funds and the threat of imposed managed care - agreed to
> support the scheme. Finally, it helps that Arkansas is a small state; when
> everyone knows everyone, it's easier to work out implementation problems.
> 
> Still, it will be a challenge. Bundled payments for hip and knee
> replacements, which have similar costs for all patients, have been
> previously tested. But for other conditions, not every patient's needs are
> the same. Some pregnant women are healthy while others have diabetes. The
> state and insurers will have to provide "risk adjustment" payments - in
> which providers are reimbursed more for treating sicker patients - and some
> patients with especially complicated illnesses may need to be excluded from
> the bundling system.
> 
> Even some low-cost conditions, like upper respiratory infections, are
> treated at widely varying costs, mainly because physicians prescribe
> different tests, numbers of office visits and medications (in 14 Arkansas
> counties, over 50 percent of patients with upper respiratory infections
> receive antibiotics, even though national guidelines say they should rarely
> be prescribed because most infections are viral).
> 
> But this is exactly what the new program will work to change, by providing
> standards for appropriate care linked to the costs of treatment and the
> quality of the doctor's performance compared with that of other doctors.
> 
> Maybe Arkansas's biggest challenge was getting the state's insurers to work
> together. On that, it has succeeded. Arkansas's two biggest private
> insurers, Blue Cross Blue Shield and QualChoice, are on board with
> Medicaid. But there is one big player missing: Medicare. To really make
> this innovation effective, the federal government should join in.
> 
> In the meantime, even as the state is working on implementing bundled
> treatments for a first round of medical conditions, it is gearing up with
> the second round. If Arkansas succeeds - even partly - it will show the way
> for the rest of the country.
> 
> -- 
> Art Deco (Wayne A. Fox)
> art.deco.studios at gmail.com
> 
>