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Understanding your insurance

Value-based care programs

Your health, financial security and peace of mind are important to us. That's why we've been working with doctors, hospitals, and state and federal government organizations to develop value-based care programs in Arkansas.

Traditionally, when you go to the doctor, a set price is paid for the services your doctor provides. The more tests and services you get, the more the doctor or hospital is paid. This is called the fee-for-service payment model. This healthcare payment model doesn't factor in the quality of your care or whether you get better.

With value-based care, payments to doctors and hospitals are partially based on keeping people healthy, rather than the number of tests or services performed. It rewards physicians for coordinating care, providing appropriate care and for positive health outcomes.

We are involved in two types of value-based care models:

  • Primary Care Value-based programs
  • Collaborative Health Initiatives

Primary Care Value-based programs

Primary Care value-based programs shift the payment structure for providers from solely fee-for-service to incorporate population-based payments to allow practices to focus on providing advanced care in innovative ways. Additionally, providers are rewarded when they help their patients improve their health and receive the care they need. The primary care value-based program we offer to providers is called Primary Care First.

Primary Care First (PCF)

Primary Care First (PCF) is a national advanced alternative payment model that aims to strengthen primary care through regionally based multi-payer payment reform and care delivery transformation. PCF aims to improve quality, improve patient experience of care, and reduce expenditures.

Primary Care First builds upon the principles of the patient-centered medical home care delivery model. These are clinics with medical teams that build relationships with patients and help coordinate their care with other medical services outside the clinic, including other resources within the community.

Most of these clinics offer:

  • 24/7 nurse help line
  • Priority appointment scheduling for high-risk patients
  • Same-day appointment slots for urgent care planned into the appointment schedule
  • Short wait times for appointments, and appointments with nurse practitioners and other medical personnel to keep the schedule moving
  • Email and websites for electronic communication
  • Surveys to improve the consumer experience
  • Access to an online care management portal
  • Focus on gaps in care, like preventive screenings
  • Care plans that track the clinic’s and patient’s health goals
  • Focus on health literacy and patient comprehension

Arkansas Blue Cross partners with CMS in this five-year national model to strengthen primary care in Arkansas. Primary Care First seeks to improve quality, access, and efficiency of primary care. PCF in Arkansas began in January 2021.

Primary First Payment Model Options

Collaborative Health Initiatives

Collaborative Health Initiatives are groups of doctors, hospitals and other healthcare professionals that come together to provide coordinated high-quality care. They are similar to accountable care organizations.

Arkansas Blue Cross collaborates with primary care physicians within a Collaborative Health Initiative to jointly manage the quality and efficiency of your care. Arkansas Blue Cross produces monthly reports with high-level information to help with the overall management of the Collaborative Health Initiatives as well as detailed reports to your doctor to support your care. Through this collaboration, the Collaborative Health Initiatives and Arkansas Blue Cross work to meet quality and financial targets.

How does this affect you?

Much of the inner-workings of value-based care go on behind the scenes, but the results can have a positive impact on the care you receive. You can find doctors and hospitals participating in some of these programs through our Find A Doctor or Hospital tool.