The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
tory infection-pharyngitis and upper
respiratory infection-sinusitis.
Informational EOCs function
much the same as a financial EOC
but with two significant differences.
Informational EOCs have no financial
incentive or gain/risk share, provide
information only, and there is no
performance period. Each quarterly
report reflects a 12-month review
with a moving average of cost and
quality of care. All other aspects of an
informational episode are the same as
financial EOCs. Beneficiaries’ episode
costs are risk-adjusted as needed,
global and episode-specific exclu-
sions are applied, and average costs
and quality of care are reported for
comparison with other PAPs partici-
pating in the episode.
Active informational EOCs include
appendectomy, hysterectomy,
uncomplicated pediatric pneumonia
and urinary tract infection. Informa-
tional EOCs currently in development
are Crohn’s disease, diabetic ketoac-
idosis, lower-back pain and percuta-
neous coronary intervention. Three
informational EOCs are in the initial
design phase: hospice oncology,
kidney stones and migraine.
MEDICAL NEIGHBORHOOD
REPORTS
The Medical Neighborhood is
Arkansas Medicaid’s data transparency
initiative. Providers are increasingly
interested in more information to
help guide quality and cost-effec-
tive improvements in their practices
and facilities. Arkansas Medicaid has
responded by creating a series of
reports that share information among
primary care physicians, specialists, sur-
geons and facilities. Medical Neighbor-
hood reports are separated into several
categories: episode-based perfor-
mance reports, episode-based PCMH
cost and quality reports, behavioral
health informational reports, and other
transparency and specialty reports.
An EOC includes claims from all pro-
viders involved in the care and treat-
ment of the beneficiary. For example, a
surgeon might be identified as the PAP
for an EOC. Claims from all providers
associated with that surgical proce-
dure are bundled into the EOC. This
would include claims from the facility
where the procedure was performed,
and claims for any radiology, pathol-
ogy, pharmacy or other services. Medi-
cal neighborhood performance
reports bridge the information gap
among providers. They are designed
to provide pertinent information to
help providers better understand and
influence treatment cost and quality.
Medical neighborhood perfor-
mance reports are currently available
for appendectomy (pending release),
uncomplicated pediatric pneumonia
(pending release), upper respiratory
infection and urinary tract infection
(pending release).
Several episode-based PCMH
cost and quality reports are cur-
rently under consideration. These
reports will share cost and/or quality
information derived from EOCs with
the primary care physician. PCMH cost
and quality reports currently under
consideration include hysterectomy,
uncomplicated pediatric pneumonia,
upper respiratory infection appendec-
tomy and urinary tract infection.
In January 2018, a new financial
profile report was published for
behavioral health services providers.
The behavioral health informa-
tional report is in a transitional stage
until Arkansas Medicaid’s behavioral
health transformation is completed
in 2019. At that time, this report will
focus solely on behavioral health Tier
1 beneficiaries (the less severe cases).
It will provide a snapshot into the
claims reimbursement activity sum-
marized by a behavioral health condi-
tion. Also, it will present information
regarding the most commonly found
behavioral health diagnoses, comor-
bidities and various demographic
breakdowns of a provider’s behavioral
health patient panel.
Additional reports are being con-
sidered as more data become avail-
able. Plans are being made to provide
a behavioral health cost contribution
report for PCMH providers as well as
quality of care reports.
Several other reports have been
or are in the process of being created
that are of interest to the medical
community. An emergency depart-
ment services report will soon be
available that summarizes both
medical and behavioral health activity
in the emergency department. Other
reports are under consideration.
In summary, Arkansas Medicaid’s
health care information has been
compiled into reports to better inform
providers and stakeholders. These
reports will help beneficiaries’ overall
health and well-being. Every report
includes a summary to help readers
understand the data and details
behind each report. This information,
along with other useful information,
can be found online at www.pay-
mentinitiative.org. s
Mr. Gallaher is a design and
development manager in Health
Care Innovation, Division of
Medical Services, Arkansas
Department of Human Services.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
DECEMBER 2018
NUMBER 6
DECEMBER 2018 • 133