By Chad Rodgers, MD, FAAP
I hope everyone is enjoying this crisp fall weather. We’ve been very busy here at AFMC. We are in the process of the re-bid for our largest review contract, which we have held for many, many years.
Things have changed in Arkansas since the last competitive bid for this work. You’ve most likely heard about the Governor’s and Arkansas Legislature’s efforts to control the costs of Medicaid. They are also working to improve efficiencies of health care delivery by developing new programs such as the Patient-Centered Medical Home, Arkansas Works and the emerging PASSEs (Provider-led Arkansas Shared Savings Entity program). We are all being challenged to deliver better care and respond to changes in payment for medical services.
This push for cost savings also applies to companies that provide services for the state. At AFMC we have worked hard to improve the efficiency of review and implement cost-saving measures to make us the leanest and most-qualified review vendor the state can find. In recent years, we have seen many large, out-of-state companies come into Arkansas to try to win business that AFMC has traditionally provided for Arkansas doctors and Arkansas patients. We know that Arkansas physicians like you know the best ways to care for Arkansans. AFMC knows first-hand how health care is delivered in Arkansas. As a result, we have been able to prevail over our competitors for this work.
We feel confident in our ability to deliver efficient, high quality and cost-effective work. As a Physician Advisor, you are an important part of that work. Thanks to the capabilities of our review platform, AFMC ReviewPoint, we have several years of data on how long it takes for every reviewer, both internal and external, to complete each type of review we perform. We use that data to improve our review efficiencies. We know some types of reviews are very long, complex and require much more time; others can be completed quickly. This ability lets us see who the outliers are and reach out to them to offer additional help completing reviews or identify other issues.
We have also studied how other organizations compensate for review. As a result, in the new review environment for 2019, we will be moving to a cost-per-review basis. This change will make AFMC an even more efficient and competitive review organization and puts us in line with the industry standard. It is also a more accurate way to predict our costs, which is critical data to have when we bid on competitive review contracts. The cost-per-review basis is based on the average amount of time for review and the complexity of certain types of reviews. This method will reward highly efficient reviewers and will give you more control over how many reviews you need to perform to meet your financial needs. We also know that there is a learning curve for starting reviewers and we are looking for payment methods to accommodate those situations.
Most recently, we have moved all our Physician Advisor payments to direct deposit. This has been tremendously helpful to our accounting staff by saving time and improving efficiency. We hope you like receiving your hard-earned dollars quicker than having to wait on a paper check to arrive in snail mail.
If you ever have questions, concerns or suggestions, please let me know. As always, we appreciate your time and valuable expertise. You help make AFMC the best.