The Philosophy Behind Arkansas Health Network and It’s Ability to Drive Millions in Shared Savings
From a national perspective, the state of Arkansas may not be known for significant advancements in value-based care.
Most often, when compared to other states, Arkansas is noted for its lowest percentile health outcomes and significantly lower than average fee-for-service payments.
But as a clinically integrated network, Arkansas Health Network has achieved growth, innovation, and repeated success with both governmental and commercial contracts for the last five years.
Arkansas Health Network was created by its parent company, CHI St. Vincent/CommonSpirit Health, in 2014 as a physician-led network with the goal of building a transformative healthcare delivery model which would benefit providers and consumers across the state. At its starting point, Arkansas Health Network included just over 400 providers (25 percent employed by CHI St. Vincent) and managed 10,976 patient lives in its Track 1 Medicare Shared Savings Program ACO as well as 7,500 CHI St. Vincent health plan employees and dependents.
Since then, under the leadership of Bob Sarkar, president and CEO, Arkansas Health Network has grown to over 2,600 participating providers, 15 hospitals, and 27 skilled nursing facilities. As of January 2021, its portfolio of covered patient lives or consumers has also expanded to over 30,000 MSSP consumers, 16,000 direct-to-employer consumers, and 70,000 consumers in other contracts, including Medicare Advantage, commercial payer ACOs, comprehensive primary care plus, and patient-centered medical homes. Mr. Sarkar was the first full-time employee hired by the organization that has added 34 team members to support the needs of the network’s providers and patients with additional planned growth.
Building on its foundational pillars of a high-value provider network, multidisciplinary care management team and advanced data and analytics platform, Arkansas Health Network has experienced repeated success in the Medicare Shared Savings Program. Since 2014, the ACO has saved Medicare $35.7 million and earned $18.2 million in shared savings, including three years in a row of earned performance payments from 2017 to 2019. See Table below.
In 2019, Arkansas Health Network was the highest-earning MSSP ACO in the CommonSpirit Health national system. In 2019, its MSSP ACO achieved a quality score of 92.2 percent.
“We decided to take upside and downside risk in the shared savings ACO because we wanted to make sure we had that core competency as we evolved, which is helpful to payers and employers,” said Mr. Sarkar. “We have seen sustained success in our savings.”
Over the last five years, Arkansas Health Network has leveraged the same successful model of care and innovative partnerships to record savings and bring value for Arkansas employers. In 2018, Arkansas Health Network partnered with Arkansas Children’s Care Network, a pediatric clinically integrated network, to manage care for the entire family. With employer clients, the CINs collaborate on care management and quality improvement for health plan members. Arkansas Health Network brings its expertise specifically to the adult members, while Arkansas Children’s Care Network focuses on pediatric members. In one example, this partnership demonstrated its success by lowering year-over-year healthcare costs for a local lumber company, Anthony Timberlands. Together, Arkansas Health Network and Arkansas Children’s Care Network generated 14 percent savings for Anthony Timberlands in 2019.
Since then, more employers have become interested in the network, Mr. Sarkar said, due to the expanded services and urgent need for companies to lower healthcare and insurance costs amid the pandemic. Arkansas Health Network and Arkansas Children’s Care Network’s model is unique because as CINs, they are willing to accept double-sided risk in their value-based arrangements, assuring employers see value. In 2020, Arkansas Health Network and Arkansas Children’s Care Network partnered with Next Health, another clinically integrated network based in the Northwest Arkansas region, increasing their combined provider network to over 3,100 providers which can serve employers with a statewide presence.
Mr. Sarkar credits a number of functional and strategic factors to Arkansas Health Network’s unique success throughout its lifespan. From a functional perspective, Arkansas Health Network has created a strong multidisciplinary care management team with the competencies to serve patients across the care continuum, including registered nurse health coaches, registered nurse transition coaches, social workers and registered nurse facility relations coordinators for post-acute locations. The team’s outreach work is data-driven, using a software that aggregates both claims and clinical data to risk-stratify patients and identify “hot spots” for quality, cost, or utilization improvement. The team examines patients daily through telehealth and in-person visits in the software. In the event of occurrences like new diagnoses, high-risk lab results, or repeat emergency room visits, the team can respond quickly, connect with the patients and their providers, and use motivational interviewing training to identify goals and the necessary steps to achieve them.
In addition, Mr. Sarkar credits physician engagement for the network’s success, which started from the top down.
“We have a very high-performing, engaged board of directors and managers,” he said. “We get real-time experience from the physicians to continually improve the model.”
Since the network was able to achieve savings right away, the physicians took ownership of the organization.
“We have a good relationship with our core group of physician partners, including the CHI St. Vincent Medical Group, and offer unique resources for our providers to support them in delivering uniform care,” said Mr. Sarkar.
These unique resources include a provider-facing team of registered nurse practice coaches and a network pharmacist.
From a strategic perspective, Arkansas Health Network has had continuous support from market, divisional and national leadership within CHI St. Vincent/CommonSpirit Health. CHI St. Vincent executives saw that Arkansas Health Network created a path to increase relevance for the entire health system with local payors and employers.
“CHI St. Vincent is a health system that is already a low-cost provider, and now we are becoming the high-value provider,” said Mr. Sarkar. “We don’t just want to be cheap; we also want to provide the most value in care.”
Mr. Sarkar said he learned early in his career as a healthcare leader that building a strong team is essential to success. He has held leadership roles with Illinois-based Presence Health, Advocate Health Care and Oakland, Calif.-based Kaiser Permanente, taking away important lessons from each role.
“We take a lot of time selecting our leadership team and didn’t just consider technical skill and ability to coach, but also the soft skills,” said Mr. Sarkar. “We thought about what we value in partnership. In order to be a good leader in healthcare, you have to be a good communicator and collaborator. You have to be methodical in your thought processes. Treat everyone as if they were part of your family. We feel that if we take care of our team, then they will take care of the work.”
Diversity and inclusion is another important aspect of a strong team, Mr. Sarkar said. His team includes members early and late in their careers and from various backgrounds to complement each other. All team members align around the common mission of providing excellent care, building healthy communities while embracing the values of CommonSpirit Health.
Finally, a fundamental part of Arkansas Health Network’s culture is being innovative and responsive to market forces, including willingness to transform or disrupt the status quo.
“At Arkansas Health Network our mission is to work hard and stay focused. I wrote ‘work faster’ on my white board. We have to keep up with the pace of change in healthcare,” said Mr. Sarkar. “We want to function as a team and support each other. We are focused on success and celebrate wins.”