State panel advances health targets

LITTLE ROCK — A state advisory panel Monday voted to approve the Arkansas Department of Human Services’ recommendations for performance targets in 2022 for health insurance providers participating in the next version of the state’s Medicaid private-option program.

The state’s expanded Medicaid program, dubbed ARHOME, is set to take effect Jan. 1. Officials expect the program to gain federal approval in the next few days.

ARHOME, which stands for the Arkansas Health and Opportunity for Me program, will provide private health insurance funded by Medicaid for low-income people. The current version is called Arkansas Works, which had 330,421 people enrolled as of Nov. 1, according to the Department of Human Services website.

William Golden, medical director of the state’s Medicaid program, told the Health and Economic Outcomes Accountability Oversight Advisory Panel that the department opted to base its target measures for health insurance providers on numbers from 2019 and 2020.

The panel was created by the ARHOME legislation, Act 530 of 2021, so it does not become an official entity until Jan. 1. Its members include legislative committee chairmen, state agency heads, Secretary of Human Services Cindy Gillespie, Surgeon General Greg Bledsoe, the head of the Arkansas Minority Health Commission and community stakeholders.

For measures where a higher number is preferable, such as cancer screenings and preventative care provided to eligible populations, the target will be the highest percentage achieved by any qualified health plan in 2019 or 2020.

For instance, Blue Cross Blue Shield screened the highest percentage of women ages 50-64 for breast cancer

in 2019 at 54%, so all insurance providers would now have to meet that mark.

For measures where a lower number is preferable, such as hospital admission rates for chronic conditions including diabetes and asthma, the target would be the lowest percentage achieved by any qualified health plan in 2019.

Qualified health plan refers to a health insurance plan that meets the requirements established by the federal Affordable Care Act, or Obamacare.

That approach takes into account the decreased use of health care services and decreased hospital admissions among Americans in 2020 as a result of the coronavirus pandemic, Golden said.

The Human Services Department is considering a variety of potential consequences for insurance providers that do not meet the targets, including corrective action plans for persistent poor performance and financial penalties beginning in 2023.

Gillespie said it “will be a good bit of work to get the numbers up,” but doing so will lead to better health outcomes for many Arkansans.

“If we are able to get to the highest of ’19 or ’20 in most of these categories … we will see significant improvement. There’s some pretty big swings in here,” she said.

The state House Public Health, Welfare and Labor Committee chairman, Rep. Jack Ladyman, R-Jonesboro, made the motion to approve the department’s recommendations.

Dennis Smith, senior adviser for Medicaid and health care reform at the Human Services Department, said after Monday’s meeting that officials are working through the final terms and conditions for federal approval of ARHOME.