much of reported improvements is attributable to better medical practice
and how much to system-gaming is a subtle issue worthy of clear-eyed
research, and reports of APII successes deserve scrutiny.
Nevertheless, on the whole the early results from APII implementation
seem promising. Moreover, providers receive online feedback not only on
costs but also on quality measures for each episode type.130 This
information will serve as an important educational and motivational tool.
As further episodes of care are deployed, these measures seem likely to lead
to a gradual but significant positive change in both perspectives and
behavior among Arkansas’s health care providers.131
2. Patient-Centered Medical Homes
The “Patient-Centered Medical Home” (PCMH) is a concept that
models how primary care practice can be organized to deliver its core
functions successfully.132 The concept has attracted an extensive academic
literature.133 The structure and operations of “Medical Homes” vary
depending on the local health care environment.134 But the concept’s core
functions and attributes are captured in concise form by HHS’s Agency for
Healthcare Research and Quality:135
(a) Comprehensive care: The primary care medical home is
accountable for meeting the large majority of each patient’s
physical and mental health care needs, including prevention and
wellness, acute care, and chronic care. . . .
bonuses for good treatment, 22% were assessed penalties for treatments above target range)
with Bonuses for Care Costs, supra note 111 (reporting that Blue Cross/Blue Shield awarded
bonuses to 85 providers and penalized 35). See also STATEWIDE TRACKING REPORT, supra
note 103, app. B, at 8-15 (tracking 2012-2013 movement of PAPs among “Commendable,”
“Acceptable,” and “Unacceptable” ratings for five episode types).
130. STATEWIDE TRACKING REPORT, supra note 103, at 9; see also HEALTH CARE
PAYMENT IMPROVEMENT INITIATIVE, http://www.paymentinitiative.org/Pages/default.aspx
(online data portal for providers).
131. Chernew et al. detected among providers “a certain sense of inevitability” about
the need to adapt to the new payment model, since most payers have adopted it. Chernew et
al., supra note 7, at 36.
132. U.S. Dep’t of Health & Human Servs., Agency for Healthcare Research & Quality,
Defining the PCMH [hereinafter Defining the PCMH], http://pcmh.ahrq.gov/page/defining-pcmh.
133. See, e.g., Thomas C. Rosenthal, The Medical Home: Growing Evidence to Support
a New Approach to Primary Care, J. AM. BD. FAM. MED. 427 (2008); Alain C. Enthoven,
Francis J. Crosson & Stephen M. Shortell, ‘Redefining Health Care’: Medical Homes or
Archipelagos to Navigate? 26 HEALTH AFF. 1366 (2007); Calvin Sia et al., History of the
Medical Home Concept, 113 PEDIATRICS 1473 (2004).
134. See Defining the PCMH, supra note 132 (explaining the five functions and
attributes of medical homes).
135. The description of the core functions and attributes of patient-centered medical
homes herein is taken from Defining the PCMH, supra note 132.