The Journal of the Arkansas Medical Society Issue 11 Vol 114 | Page 6

by BRENT DAVIS
Arkansas Blue Cross and Blue Shield
Begins VBCI Implementation
T
he winds of change blow con-
stant in the health care industry
and a new breeze is forming .
Arkansas Blue Cross Blue Shield has begun the
process of switching payments to medical provid-
ers from the longstanding Fee-for-Service (FFS)
structure to a new systems called the Value-Based
Compensation Initiative, or VBCI. While some see the
change from FFS as inevitable, others seek answers
and details of the new program.
Steven Spaulding, executive vice president and
chief health management officer at Arkansas Blue
Cross and Blue Shield, explains how VBCI will work.
“A portion of the payment to providers will be
directed to a value pool.” says Spaulding. “Funds in
that pool will be distributed each quarter to providers
based on their RowdMap score. Providers who score
well on that system will get a greater portion of that
distribution than those who score poorly. This redis-
tribution is intended to compensate providers at a
higher level for providing high value care as informed
by RowdMap using Dartmouth Atlas and Choosing
Wisely criteria.”
RowdMap is a company that has studied the
work of Choosing Wisely, an organization comprised
of over 70 physician specialty societies, and the
Dartmouth Atlas of Health Care that has done work
for many years with participation by physicians to
identify variation in cost and quality of care. Rowd-
Map has built algorithms using the work of these
organizations as a provider-informed source of in-
formation and is able to score individual providers
based on the overall value of services on a compara-
tive basis in defined geographic areas. 
So how will Arkansas Blue Cross and Blue
Shield determine “low-value” versus “high-value”
treatment? The major insurance provider in the
state will use its claims data to create “value”
scores for providers that measure low- versus
high-value care based on evidence-based medi-
cine from well-respected resources within the
medical community, including national provider
associations. These value scores will be used to
distribute value payments to providers.
In 2019, Arkansas Blue Cross and Blue Shield
will begin stepping down fee-for-service compensa-
tion over a four-to-five-year period until base fee-
for-service compensation approximates Medicare.
The funds from this step down of fee-for-service
monies will be placed into three separate value
pools — hospital, specialist and primary care. These
value pools make up the value-based compensation
component.
On a quarterly basis, 100% of the value-pool
funds will be distributed to providers based upon a
set of value-based performance metrics using the
most recent and available 12-month performance
period, which will roll forward every quarter. These
performance metrics, as stated ear-
lier, will be based primarily upon a
claims-based scoring methodology
developed by RowdMap, with sourc-
es from Choosing Wisely (www.
ChoosingWisely.org), the Dartmouth
Atlas (www.DartmouthAtlas.org),
and other evidence-based clinical
guidelines and research studies.
The average American family spends more than
$4,000 annually on direct and indirect costs driv-
en by low-value c