Three ‘provider-led’ groups receive approval for ‘organized care’ of special needs patients

by Michael Tilley ([email protected]) 2,784 views 

Three “provider-led” entities that provide care to around 35,000 special needs patients in Arkansas using Medicaid funds have been granted the first licenses under a new state law designed to provide improved care and outcomes using “wrap around services.”

Act 775 of 2017, the Medicaid Provider-Led Organized Care Act, was sponsored by Rep. Aaron Pilkington, R-Clarksville, and signed into law by Gov. Asa Hutchinson. The law is designed to allow providers to create a type of insurance network targeted solely for those in Arkansas with severe intellectual and physical medical needs.

That vehicle is known as the “Provider-led Arkansas Shared Savings Entity” (PASSE).

“It is a new model of organized care that will address the needs of certain Medicaid beneficiaries who have complex behavioral health and intellectual and developmental disabilities service needs,” according to the Arkansas Insurance Department (AID).

Brandi Hinkle, deputy chief of communications for the Arkansas Department of Human Services, said the process creates a network of therapists, counselors, doctors and other providers who develop “care coordination” for the patients. The coordination reduces duplication of services, seeks to put all caregivers on the same page and “ideally addresses issues” before they become a more serious problem for the patient and a more expensive solution for the providers, Hinkle said.

Arkansas Insurance Department Commissioner Alan Kerr on Monday (Oct. 23) granted PASSE authority to three of five groups who have applied.

“I am proud to issue the first licenses to provider-led organizations under Act 775 and welcome them as domestic insurance companies. These companies have demonstrated initial financial resources and organizational structure as well as adequate network coverage as deemed by the Department of Human Services. This is an important step for Arkansas in establishing a unique system to serve Medicaid beneficiaries,” Kerr said in the statement.

Following are the three entities who received a license:

• Arkansas Total Care, Inc. (ATC)
ATC is a wholly owned subsidiary of Arkansas Total Care Holding Company, LLC. The ownership of the holding company is held by Mercy Health System, LifeShare Management Group, and Arkansas Health & Wellness Health Plan Inc. LifeShare and AHWHP are owned by Centene Corp. Mercy’s system includes 44 acute care and specialty hospitals, more than 700 physician practices and outpatient facilities and more than 2,000 Mercy Clinic physicians in Arkansas, Kansas, Missouri and Oklahoma. LifeShare develops and delivers person-centered solutions for people with intellectual and developmental disabilities through manage care, state, and health organizations across multiple states. AHWHP is an Arkansas domestic health maintenance organization.

• Arkansas Advanced Care, Inc. (AAC)
AAC will be owned and operated by Baptist Health, Bost, Inc., the University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, and USAble Corporation.

“The members of AAC advocate the goal to ensure that Arkansas’s residents receive the high quality, efficient care with innovative delivery and payment arrangements and population health programs to help transform Arkansas to an organized system of care,” noted the insurance department statement.

• Empower Healthcare Solutions, LLC (EHS)
EHS is comprised of Beacon Health Options, Inc., Woodruff Health Group, LLC, Independent Case Management, Inc., Preferred Family Healthcare, Inc., Arkansas Community Health Network, LLC, The Arkansas Healthcare Alliance, LLC, and Statera, LLC. Beacon is an independent privately-owned company and one of the nation’s largest organizations that assesses and address the clinical needs of individuals who are experiencing mental illness, addiction, and developmental disabilities.

Hinkle said the three groups will cover around 35,000 patients.

“(W)e are currently spending $1 billion annually on this group of beneficiaries. We don’t have an estimate of savings, but we hope to see that care coordination helps this group better utilize preventative treatment, medication adherence and a decrease in unnecessary emergency department usage. DHS has not determined the actuarially-sound global payment amount but will begin that process in the spring,” Hinkle told Talk Business & Politics.

According to DHS, the goals of PASSE are:

• To improve the health of Arkansans who have need of intensive levels of specialized care due to mental health, intellectual or developmental disabilities;
• To link providers of physical health care with providers of behavioral health care and services for individuals with developmental disabilities;
• To coordinate care for all community-based services for individuals with intensive levels of specialized care needs;
• To reduce excess cost of care due to under-utilization and over-utilization of services;
• To allow flexibility in the array of services offered to the population served; and
• To increase the number of service providers available in the community to the population covered.

The state agency also says the program should reduce costs by organizing care, and “not just by managing finances.” To that point, Hinkle said the agency conducts annual reviews to make sure patient care is not reduced in order to simply improve finances.

“We regularly do quality assurance to make sure that a diagnosis is being treated appropriately based on standards across the country,” she said.

The first phase of PASSE began Oct. 1, 2017. Additional patients are expected to be added in January 2018 based on assessments by the AID and DHS. The second phase begins Jan. 1, 2019. It’s in this phase where the provider-led groups will receive payment “for each enrollee to cover the administration costs and benefits for each patient, while ensuring a level of savings for the state.” Hinkle said one example of a phase 2 cost-savings goal is the reduction of unnecessary medical tests.