HJAR Jan/Feb 2024

38 JAN / FEB 2024 I  HEALTHCARE JOURNAL OF ARKANSAS MEDICAID PATIENT-CENTERED MEDICAL HOME PROGRAM COLUMN MEDICAID simultaneous presentations in one patient, such as diabetes, hypertension, and conges- tive heart failure. Given these issues, Arkansas also developed the PCMH payment model in 2014 to work in tandem with its episodic payment approach. Like many largely rural states, Arkansas has geographic areas served only by small medical practices with modest infrastructure. Most of these practices have three or fewer physicians. High rates of uninsured patients and a reliance on Medicare and Medicaid reimbursements make it a challenge to sustain robust primary care practices. In this context, Arkansas’ PCMH payment IN 2011, Arkansas rolled out a comprehensive payment reform tomove from a combination of private and public payments to a value- based purchasing model built around service episodes. An underlying goal of this effort was to incentivize quality and cost-effective care delivery rather than volume of services provided. However, this episodic approach focus- es mostly on acute conditions and rewards providers who meet quality targets and pro- vide lower average risk-adjusted spending per episode. Chronic care patients are more difficult to fit into an episode-based system. It is challenging, for example, to design chronic care management episodes to account for Arkansas’ Patient- Centered Medical Home (PCMH) program recently received the Center for Evidence- Based Policy’s inaugural Evidence- Based Innovation Award. But what makes the PCMH program here in Arkansas so innovative?