Progress in the Arkansas Provider-Led Managed Care
We take a look at Arkansas' provider-led network as a groundbreaking new model for Medicaid consumers. Their whole-person approach is a true example of what value-based care can offer consumers and providers.
THE VBP Blog
Arkansas’s unique provider-led program creates both opportunities and challenges as they try and find the best way to work with the Medicaid long-term services and supports (MLTSS) community. The program was dubbed the Provider-led Arkansas Shared Savings Entity (PASSE). The PASSE consists of entities that must contain 51% provider ownership making them the only provider-led network in the U.S. Last year, we wrote about the program when we covered the I/DD Managed care programs.
This provider-led program is something we strongly believe in as it offers a true whole-person care approach and is a great example of what value-based care can do. We are eager to see how it pans out.
The PASSE program works with those with behavioral health and intellectual/developmental disabilities receiving services through the DD Waiver. Arkansas also has additional programs for the MLTSS community, we dig into those later in the blog.
About Arkansas' PASSE
The Provider-Led Arkansas Shared Savings Entity (PASSE) brings partners together into new partnerships to provide similar administrative functions similar to how an insurance company operates. Under Act 775, the governing body of each PASSE must include several types of providers licensed or certified to deliver services in Arkansas including a Developmental Disabilities Services specialty provider, a Behavioral Health Services specialty provider, a hospital, a physician, and a pharmacist.
PASSEs are a Medicaid provider type approved by the Centers for Medicare & Medicaid Services (CMS). They are regulated by the Arkansas Insurance Department (AID) and held accountable to the Department of Human Services (DHS) under federal managed care rules.
The PASSE Roll Out
PASSE launched Phase 1 of their program in 2018, where four Managed Care Organizations (MCO’s) assumed care coordination. MCO’s manage these consumers with the intent to improve quality, decrease costs, reduce time, and better predict costs. Phase 1 consisted of the MCO’s creating the infrastructure necessary to manage the Medicaid consumers. Only 3 MCO’s are Arkansas Total Care (Centene), Summit Community Care (Anthem), and Empower Healthcare Solutions continued to Phase II that started in 2019. In Phase II, PASSEs are responsible for the total cost of care and accept full risk under the MCO model.
As we mentioned above, we strongly believe in the provider-led model. However, the exit of one of the plans and the implementation of the full risk model bring an increased focus on the long-term economic viability, but we are optimistic.
In April 2021, MCO CareSource was added to coordinating LTSS individuals and those with intellectual and development disabilities (I/DD). The MCOs now handle about 45,000 Medicaid-eligible individuals.
According to Arkansas’ Human Services website, a care coordinator from assigned PASSE contact each member within 15 days of their effective enrollment date. Their Person-Centered Service Plan (PCSP) consists of helping each member through their case, making sure to make contact at least every 30 days. This leans into whole-person care if done correctly.
Initially, consumers were unhappy with how their care was being handled. According to disabilityrightsar.org, there are multiple stories of mishandled assessments, long wait times, and a lack of options.
Arkansas offers 4 additional programs for the MLTSS community. The first is called a Program of All-Inclusive Care for the Elderly (PACE) that is an innovative program that works to keep elderly adults over the age of 55 in the community as long as possible through the HCBS waiver. ARCHoices is a Homecare program for individuals over the age of 21 that need help with Activities of Daily Living (ADLs). Assisted Living Facilities, Development Disability Services, and Nursing Facilities are also options.
Consumers have and will continue to undoubtedly benefit from the PASSE system. After the kinks were worked out, there has been a high level of person-centric care. Care coordination has been generally seamless and has continued to put consumers first. The providers can offer high levels of care through their network and create a lower cost of care, which is important to both the MCO’s and the consumers. The community of providers and MCO’s can benefit from close monitoring of the programs in Arkansas and we will be right along with learning and sharing with them.
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.