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:

 

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.

 

 The report cover of each document will indicate the report type.  Click here for a report glossary.

 

Additional information and provider support is available by contacting AHCPII Help Desk at 501.301.8311 or arkpii@hpe.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
Medical
  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
Procedural/Surgical
  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
July 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
Behavioral Health
  Attention Deficit Hyperactivity Disorder (ADHD)
JAN 1 - DEC 31
APR 30
  Oppositional Defiant Disorder (ODD)
APR 1 - MAR 31
JAN 31