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EARLY IN, BETTER OUTCOME Continued from page 19
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ARKANSAS TIMES
of medicine, which is what they are trained for. Community health workers will educate, answer questions. All will coordinate the care of each patient, not just within the medical home but with specialists and hospitals through electronic record-keeping and shared data bases. The Payment Improvement Initiative addresses how we pay for health, shifting today’s fee-for-service system — paying for each doctor visit — to paying for the treatment of the illness, an “episode” of care. This year, Medicaid and private insurers are tracking costs and outcomes in five areas of care; providers with good outcomes at lower costs will be rewarded, but those whose costs are excessive will have to pay a portion of that back. Thompson and Andy Allison, who heads Arkansas’s Medicaid program, presented ideas for cost containment to the Arkansas State Medical Board. Allison, Thompson said, told the board that Medicaid was spending $4.5 billion a year and only 8 percent of that was going to physicians. “If you help me manage the other 92 percent, I’ll share the savings with you,” Thompson quoted him as saying. Providers have told Allison and Thompson that under the current system, about 10 percent of costs are due to waste, such as duplication of services; some doctors estimated waste at 30 percent.
Two state legislators — both wives of doctors — recently expressed their objections to DHS’ payment overhaul, complaining that nurse practitioners would take the place of doctors and that doctor pay would be cut “to the bone.” Thompson, on the other hand, said the medical home and payment initiatives have “surprising support from both physicians and hospitals. ... The opportunity for the primary care physician, I think, is to reorganize his practice so his net revenue is greater.” The Comprehensive Primary Care Initiative will pay participating clinics an amount based on the number of Medicare patients each practice sees to add the personnel they need to coordinate care and create a medical home. After two years, the practices will share in the savings. Seven Robert Wood Johnson Foundation models have shown that primary practice medical homes reduce hospitalizations and ER savings, with a cost reduction of $7 to $640 per patient. UAMS will begin offering a doctorate of nursing practice in the fall, and advanced-practice nurse degree programs have begun at UA Fayetteville and the University of Central Arkansas at Conway. Nurse practitioner programs at UAMS and Arkansas State University are expected to ramp up, Thompson said. The pressure of new patients may come before the medical home becomes the standard, but state agencies are scrambling to meet the demand.