1997 Winner
Winners:
State of Arkansas
1997
Publication:
Innovations in American Government Awards
Sponsored By:
Innovations in American Government Awards
Jurisdiction:
Arkansas

Since the Federal Medicaid Program was enacted in 1965, states across the nation have struggled to effectively implement healthcare services. Physicians and impoverished residents of Arkansas found themselves all too familiar with the setbacks of the Medicaid system. Due to inadequate monetary reimbursements and a system of error-prone paper claims, many physicians refused to treat Medicaid patients entirely. Since Medicaid recipients could not locate primary care doctors, they instead crowded into public clinics and used emergency rooms for after-hours routine care. Physicians could not possibly supply continuity in their care because they were treating patients without access to their medical history, and therefore many physicians perceived Medicaid patients as an added liability. The lack of adequate continual preventative care compromised the health of the indigent population, leading to severe health problems and thus placing an even greater burden on the State and the Medicaid system.

In 1992, Arkansas joined with EDS information-technology consulting firm to tap into recent computer advances to streamline the Medicaid process with the hopes of encouraging more physicians to treat the State's most needy patients. This public-private partnership led to the creation of the Arkansas Automated Eligibility Verification and Claims Submission System (AEVCS). AEVCS entirely eliminated the time-consuming paper claims process by providing each Medicaid beneficiary with a picture ID card that activates electronic approval of the patient's Medicaid status and submits payment directly from the State to the provider. This online system made Medicaid the fastest medical payer in Arkansas, compensating for the low payment rates and significantly increasing the number of physicians who will treat Medicaid recipients.

To capitalize on the rising number of physicians who would accept Medicaid patients, the State established ConnectCare in 1994. ConnectCare is a managed-care program that allows each Medicaid beneficiary to identify and choose a primary care provider from a list of participating physicians in the area. Information regarding ConnectCare is deployed through local physicians, television public service announcements, and a 24-hour 800 hotline sponsored by the Arkansas Department of Health. By providing Medicaid recipients with a directory of contact information for primary care physicians who accept Medicaid beneficiaries, ConnectCare has empowered recipients to act as consumers, making an active decision as to who delivers their health care services. As a result, more recipients are turning to private physicians rather than the traditional public and indigent care providers.

As of January 1997, about 1,600 physicians had enrolled in ConnectCare, creating enough slots to take on a combined caseload of about 1.2 million patients, which is six times the number of Arkansas Medicaid recipients. ConnectCare linked over 145,000 Medicaid beneficiaries with primary care physicians in the two years following implementation, allowing providers to establish continuity of care and access key medical records that are so critical in achieving comprehensive treatment. As a direct result, use of emergency rooms for emergent and nonemergent care declined by more than 50 percent. A 1995 evaluation determined that ConnectCare had saved the State an estimated $30 million in health care expenditures in just the 17 months following the program's implementation. Arkansas hopes to expand the principles of ConnectCare and technical advances of AEVCS to the thousands of uninsured children in the State with the introduction of ARKids First in the fall of 1997.

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