Episodes of Care
An Episode of Care (EOC) is the bundle of Arkansas Medicaid-covered health care services provided to perform a specific procedure or treat an ailment/condition for a given length of time. EOCs are based on data from two main sources: 1) paid claims processed per standard Medicaid fee-for-service reimbursements, and 2) data submitted through AHIN (Advanced Health Information Network), a Provider Portal utilized when key data are not available through claims.
For each EOC, providers submit claims and will continue to be reimbursed per established fee schedules. A Principal Accountable Provider (PAP) is identified for each EOC through claims data. PAPs are defined as providers who have the greatest potential to influence treatment decisions, cost, and quality of care within each type of EOC. PAPs share in savings or excess costs of an EOC determined by the average cost per valid EOC and performance on quality/outcome measures as compared to peers.
An EOC’s performance period is twelve-months in duration. Quarterly reports are published for each PAP and EOC throughout the performance period culminating in the fourth and final quarterly report upon which financial incentives are determined.
An Episodes of Care’s Principal Accountable Provider Report will be one of three different types of quarterly reports (the report cover of each document will indicate the report type):
Historical Performance Report – An informational report for newly launched EOCs which provides a twelve-month historical perspective prior to the publication of an actual Performance Period Report.
Performance Period Report – A quarterly report detailing the information upon which a PAP’s clinical quality and cost performance are based. The fourth and final quarterly report is frequently referred to as the “payment” report upon which financial incentives are determined.
Reconciliation Report – A report published one year after an EOC’s fourth and final Performance Period Report. The Reconciliation Report will adjust clinical quality and cost information based on data submitted after the close of a performance period.
Click here for a PAP Report Glossary
Click here for a PAP Report Guide
Additional information and provider support is available by contacting AHCPII Help Desk at 501.301.8311 or email@example.com.
Below is a list of EOCs currently in production. The performance period and the “payment” report dates for each EOC are list below:
|Episode of Care||Performance Period||Final Performance Period Report|
|Asthma||JUL 1 - JUN 30||OCT 31|
|Chronic Obstructive Pulmonary Disease (COPD)||JAN 1 - DEC 31||APR 30|
|Heart Failure (HF)||JAN 1 - DEC 31||APR 30|
|Upper Respiratory Infection (URI)||OCT 1 - SEP 30||JAN 31|
|Cholecystectomy (CHOLE)||OCT 1 - SEP 30||JAN 31|
|Colonoscopy (COLON)||OCT 1 - SEP 30||APR 30|
|Coronary Artery Bypass Graft (CABG)||APR 1 - MAR 31||JUL 31|
|Perinatal||OCT 1 - SEP 30||JAN 31|
|Tonsillectomy (TONSIL)||OCT 1 - SEP 30||APR 30|
|Total Joint Replacement (TJR)||JAN 1 - DEC 31||APR 30|
|Attention Deficit Hyperactivity Disorder (ADHD)||JAN 1 - DEC 31||APR 30|
|Oppositional Defiant Disorder (ODD)||APR 1 - MAR 31||JAN 31|