With the cost of healthcare climbing, state and local governments are constantly on the lookout for cost-saving ways to improve the quality of health for their people. For Arkansas, their concerns were two-fold. Not only did they have to contend with the estimated eight-percent annual cost increase of Medicaid, but the state’s Division of Medical Services (DMS) was facing a potential budget shortfall of $140 million. With cuts looming, state and private groups came together to investigate a breakthrough solution to a very real problem.
Challenge: Healing a breaking system.
To lead the transformation, the Arkansas Health Care Payment Improvement Initiative (AHCPII) was born. Shifting the state’s healthcare structure from fee-for-service to a value-based rewards system: incentivizing quality care at commendable costs. And in doing so, Arkansas became the first state to successfully enact payment reform statewide.
Solution: Finding big insights in big data.
To meet the requirements of multiple state services and providers, GDIT developed an advanced data-analytics tool that used big data to influence better care. We created a secure, one-stop infrastructure accessible to both healthcare payers and lawmakers alike. First, we used claims data to identify episodes of care. Next, with that same data and clinical data, we calculated quality measures. And finally, we determined bundle payments for principal accountable providers.
Results: Saving more than costs. Saving people.
Our solution did more than provide access to a complex data in real time. It gave Arkansas’ providers and policymakers the tools they needed to effect statewide healthcare reform. Reducing costs and rewarding physicians. Since its launch, more than 320 million claims have been processed. What’s more, we helped Arkansas decrease the growing cost of Medicaid from 8% to nearly 2%, translating to a savings of $720M in just its first 3 years. But cost-savings were only one half of this success story. The other was the improved health of Arkansas’ people.
Antibiotic use for unspecified upper-respiratory infections fell by 23.5%
Increased benchmarks for gain-share-linked perinatal quality by 8%
Perinatal C-section rates were reduced by 7.4%
33.6% improvement in strep tests with prescribed antibiotics
30-day outpatient care rate for heart failure decreased by 7.9%
Increased follow-up visits for heart-failure patients within 14 days by 12.4%
Average episode costs dropped between 2.9 and 9% for non-specific and sinusitis upper-respiratory infections, cholecystectomies, and colonoscopies
And 73% of Arkansas Medicaid providers either saw overall costs improve or remain commendable
“As a state system, we are now harnessing our data to give the providers more information about the care they give… we are helping the provider community come up with new systems of care and reward[ing] them for doing it well."
William Golden, MD, MACP Arkansas Medicaid Medical Director