Arkansas Comprehensive Primary Care Initiative

Program Location: 
Little Rock, AR
Number of Practices: 
Payer Type: 
Arkansas BlueCross BlueShield
Arkansas Medicaid
QualChoice of Arkansas

In September 2012, Arkansas was chosen as one of seven markets to participate in the Comprehensive Primary Care initiative. This multi-payer initiative brings together five payers including Medicare, 63 participating primary care practices (originially 69 but 6 practices are no longer participating) and 275 providers serving over 54,000 beneficiaries across the state.  The Center for Medicare and Medicaid Services (CMS) will pay a management fee of $20 PBPM to participating physicians/clinics who agree to provide enhanced services such as staying open for longer hours on weekends or providing counseling about nutrition and how to stop smoking. They also include a commitment to coordinate care for the patient, especially for those with special needs and chronic diseases. Simultaneously, participating commercial, state and other federal insurance plans will offer enhanced payment to primary care practices. Selected practices may also receive shared savings payments in the later years of the initiative.

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Payment Model: 

Under the Comprehensive Primary Care Initiative, CMS will pay primary care providers for improved and comprehensive care management, and after two years offer them the chance to share in any savings they generate. CMS will look to collaborate with other payers in local markets who will commit to similar changes to how they engage primary care practices.

  • Monthly Care Management Fees for Medicare Fee-for-Service Beneficiaries: CMS will pay participating practices a risk adjusted, monthly care management fee for their Medicare Fee-for-Service beneficiaries. For the first two years of the initiative, the per-beneficiary, per-month (PBPM) amount will average out to $20; for years 3 and 4, the PBPM will be reduced to an average of $15.
  • Shared Savings in Medicare Fee-for-Service: After two years, all practices participating in this initiative will have the opportunity to share in a portion of the total Medicare savings in their market.
Fewer ED / Hospital Visits: 

Mathematica Evaluation (January 2015Independent evaluation of first program year prepared for CMS

  • Among all patients in Arkansas, there was one statistically significant, favorable result for the CPC group relative to the comparison group:
    • An annual decline of 328 primary care clinician visits per 1,000 patients in all settings (4 percent).
  • Among high-risk patients, as Table 8.5 shows, there were statistically significant annual declines per 1,000 beneficiaries of:
    • 859 primary care clinician visits per 1,000 patients across all settings (6 percent).
    • 762 specialist visits across all settings (4 percent).
Improved Health: 

Mathematica Evaluation (January 2015Independent evaluation of first program year prepared for CMS

Among all patients and high-risk patients, there was only one favorable statistically significant impact and one unfavorable statistically significant impact on the claims-based quality-of-care process or outcome measures in Arkansas:

  • The percentage of beneficiaries with IVD who received a lipid test increased by 2 percentage points (3 percent) for all patients.
  • The percentage of beneficiaries receiving a 14-day follow-up visit after hospital discharge declined by 4 percentage points (6 percent) for high-risk patients only. 
Other Outcomes: 

Mathematica Evaluation (January 2015Independent evaluation of first program year prepared for CMS

Statistically significant findings for the CPC group relative to the comparison group during the first year include: 

  • Average monthly Medicare expenditures with care management fees increased by $22 (3 percent) among all patients in Arkansas
  • Average monthly Medicare expenditures on hospice services increased by $4 (23 percent)
Last updated January 2016
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