The Arkansas Innovation - worth watching

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Interesting article on the Opinion Page of the New York Times today. Arkansas is experimenting with the idea of moving away from a fee-for-service model to a bundled model of paying for Medicaid services. At the heart of the process is the "Quarterback." This is how it will work (from the article):

  • "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."

Football fans know full well that even the best quarterback needs a playbook and a team of coaches to keep him or her from going rogue. Those who ascribe to system of care values and principles will be intrigued with the Arkansas experiment but also know full well the danger of being incentivized to keep the costs down. So good for you Arkansas for being innovative and important for Arkansas children's mental health advocates to follow this experiment closely to ensure that families are fully involved with identifying "good care."

Read the article here.


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