Arkansas is not a healthy state. At least that’s what the data say.
The state ranked 49th on the United Health Foundation’s most recent "America’s Health Rankings" report. How did the state get so low? Among other things, 34 percent of Arkansans are obese and childhood immunization rates are among the lowest in the nation. A couple of years ago, a state report found that barely 30 percent of diabetic or hypertensive patients believed their conditions were under control.
So, you could hardly be blamed for failing to think of Arkansas as a model of health care innovation. But spend a few moments listening to Joseph Thompson, M.D., the state’s surgeon general and director of the Arkansas Center for Health Improvement, and you’ll hear about efforts to spread the use of patient-centered medical homes, adopt health information technology and advance team-based care.
Thompson took part in a Centers for Medicare & Medicaid Services press call in mid-December about the second round of State Innovation Models funding. Since 2013, CMS has awarded nearly $960 million to states eyeing efforts to transform care delivery systems. Arkansas was involved in the first phase of funding in 2013, receiving $42 million. During the call, Thompson proselytized about efforts of stakeholders across the state to come together with a unified vision. Early results are positive, he said. He cited one solo practitioner in the Ozark Mountains who saw hospitalization rates for a panel of patients drop 44 percent thanks to a team-based care initiative. He also noted that close to 80 percent of the state’s Medicaid beneficiaries are now covered by a patient-centered medical home.
How much further Arkansas can go likely will be determined by a political debate taking place in the state. New legislative leaders are threatening to thwart Medicaid expansion under the Affordable Care Act.
“CMS believes that states are laboratories of innovation,” Patrick Conway, M.D., CMS’ deputy administrator for innovation and quality and chief medical officer, proclaimed during the press call.
That’s long been the case for, well, just about everything, but it seems to be playing out on a larger scale these days in health care. As staff writer Paul Barr points out on Page 31, state Medicaid programs are experimenting with payment reforms and moving further away from the traditional fee-for-service model.
The Kaiser Family Foundation reports that more than half of Medicaid beneficiaries nationwide are enrolled in managed care organizations, most of which rely heavily on capitated rates, shifting a large part of the financial burden onto providers. Twenty-three states plan to grow their Medicaid managed care portfolios in 2015.
That’s not to say that Medicaid managed care is the silver bullet for what ails the system, but various federal waivers are allowing state officials to experiment and be more adventurous as they search for answers.
What’s more, the CMS grants give states the ability to look beyond public programs for reforms. As Thompson noted, private payers and large employers, including Walmart, are part of the conversation.
“If we were going to change the delivery system, no one payer has the power to do it themselves,” he said. “We needed to do it together.” — You can reach me at firstname.lastname@example.org.