payers joined to provide financial support to those practices to begin the
PCMH transformation.139 That federally-led initiative was the genesis of a
state-based PCMH initiative to cover a great many more practices with an
emphasis on the pediatric population.140 As of December 2014, 780
Medicaid primary care providers are participating, and 309,000 Medicaid
beneficiaries are covered by the program. This represents 73% of all
eligible providers and 80% of all eligible beneficiaries.141 These
participation figures are promising, but (as the state website recognizes)
they do not present detailed evidence on whether the program is meeting its
cost and quality goals.142
The Patient-Centered Medical Home program is ramping up statewide,
beyond existing voluntary efforts by the state’s domestic private insurers.
Starting in 2015, Arkansas requires all qualified health plan issuers in the
Health Insurance Marketplace to participate not only in the “private option”
but also in the Patient-Centered Medical Home program, bringing into the
value-based payment structure a large number of additional beneficiaries
and the potential for additional primary care practices.143 By 2017,
Arkansas expects that patient-centered medical homes will serve the
majority of Arkansans.144 As the former state Medicaid director observed,
“the Private Option and [the Arkansas Payment Improvement Initiative] are
now symbiotic: one accelerates and leverages the other.”145
3. Health Homes
A third aspect of Arkansas Payment Improvement Initiative, not yet
implemented, is the “Health Homes” project.146 Authorized by § 2703 of the
139. STATEWIDE TRACKING REPORT, supra note 103, at 5; Wilson March 2015
interview, supra note 77.
140. STATEWIDE TRACKING REPORT, supra note 103, at 5. A video overview of the
qualifications for participation in Arkansas’s Patient-Centered Medical Home program, of
the initial results, and of the shared-savings payment structure is available online. PCMH
Overview Webinar, HEALTH CARE PAYMENT IMPROVEMENT INITIATIVE, http://
www.paymentinitiative.org/medicalHomes/Pages/default.aspx (last visited Apr. 9, 2015)
(click “PCMH Overview Webinar” tab).
141. STATEWIDE TRACKING REPORT, supra note 103, at 6.
142. Id. at 5.
143. ARK. INS. DEPT. R. 108 (codified at ARK. CODE ANN. §§ 20-77-2401 et seq.),
available at http://www.insurance.arkansas.gov/index_htm_files/Rule108.pdf (last visited
Apr. 9, 2015) (effective Jan. 1, 2015).
144. STATE INNOVATION PLAN, supra note 19, at 3; BACHRACH ET AL., supra note 11, at
145. BACHRACH ET AL., supra note 11 (quoting Dr. Andrew Allison).
146. See generally Health Homes, HEALTH CARE PAYMEN T IMPROVEMENT INITIATIVE,
http://www.paymentinitiative.org/healthHome/Pages?Health-Homes.aspx (explaining how
the “Health Homes” program is designed to work).