HJAR Nov/Dec 2019

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2019 37 perceptions of their health care, and of the insurance programs that help provide need- ed services. It is a lengthy survey that runs nearly 40 pages, and the randomized receipt of this questionnaire by patients can be in- timidating. Indeed, a 20 to 35 percent return of useful survey documents is considered a good yield for a CAHPS analysis. Arkansas Medicaid has been using CAHPS on a regular basis for many years. Patient responses are compared to previous years’ results to look for improvement or deterioration in specific aspects of the program. It can also be used to compareArkansas’s Medicaid program to those in other parts of the country. As part of the CAHPS survey, patients re- port their educational attainment and per- ceived health status. The data clearly dem- onstrates that Arkansas Medicaid patients have a lower reported educational attainment and perceived health status than respond- ing Medicaid patients in other regions of the country. Our state’s population also has a much higher rate of behavioral health burden and tobacco use compared to other states. Arkansas Medicaid providers, therefore, care for sicker patients who have more limitations in health literacy. Recent Arkansas CAHPS data regarding quality of care were mostly positive, espe- cially regarding pediatric services. Parents reported that their children received care quickly and that their doctors communi- cated effectively at rates equal to or above the national benchmark data. Adult data were comparable to national benchmarks, but also highlighted areas for improvement. Perceptions of the performance of the ad- ministration of the Medicaid programmade significant improvements since the last CAHPS survey. The U.S. Secretary of Health and Human Services (HHS) issues an annual report of Medicaid clinical performance measures. Data submission is currently voluntary. Ar- kansas Medicaid submits nearly 50 percent of requested metrics to HHS by focusing on metrics that can be calculated from analysis of clinical billing information. Arkansas does well on several measures: •• Low rates of early elective delivery •• Low use of antipsychotic medicine in young children •• Emergency room utilization per 100 patients •• Follow up after an acute behavioral health encounter Other measures could use some improvement: •• Well-child visits in the first months of life •• Breast and cervical cancer screening •• Diabetes testing Tying these metrics to financial bonuses has resulted in better performance and a stronger state profile in the annual national report. Similarly, the Agency for Healthcare Re- search and Quality also publishes an annual national review of health care disparities, pa- tient safety, and health care quality. It calcu- lates a variety of measures from aggregated claims set at the federal level. Arkansas, in the not-too-distant past, had weak profiles in this annual report, but this year, published billing data from 2017 placedArkansas solidly in the average zone, with a trend toward achieving above-average performance as a state. Arkansas Medicaid takes these global as- sessments and develops specific metrics to compare individual providers in different parts of the state. Data from these reports help the program select quality measures to provide an incentive for our hospital Pay for Performance program and the Patient Cen- teredMedical Home (PCMH). Thus, Arkansas Medicaid uses the federal efforts to identify where to focus on implementing metrics and incentives at the local level. Incentive programs have markedly im- proved Arkansas’s performance on: •• Early elective deliveries •• Breast-feeding •• Follow-up after behavioral health hospitalizations •• Antipsychotic use in children •• Well-child visits The programwill continue to identify op- portunities to make reasonable requests for data from health care institutions and pro- fessionals in the state to ensure accountable health system performance. This analysis is essential to make Arkansas Medicaid com- parable, accountable, and competitive when compared to other parts of the country. Thus, ongoing data analytics drives are integral for programmanagement to provide appropriate oversight of clinical care received in facili- ties in our communities, and to assure that the program is using resources to improve population health. n WilliamGolden, MD Medical Director Arkansas Medicaid Arkansas Medicaid uses the federal efforts to identify where to focus on implementing metrics and incentives at the local level.