Primary Care Physician Profiling Program

The Arkansas Medicaid ConnectCare Program is based on the Primary Care Case Management model. Primary Care Physicians (PCP’s) are paid a monthly management fee to be the gatekeeper for all care rendered to the enrollees who have selected them as their PCP.

Our Goal

To provide meaningful cost and utilization data to ConnectCare PCP's that will allow providers to effectively monitor and manage utilization and costs for their patients.

PCP Profile Report

We create and disseminate the PCP Profile report quarterly to all ConnectCare PCP's with an average of 10 or more enrollees during the period. The report provides the following information:

• Costs and utilization rates for pharmacy, PCP, referrals, ER, and hospitalization during the given quarter, and the most recent 12-month period, for both the individual PCP practice and the statewide ConnectCare program
• Cost and utilization trends since the inception of the ConnectCare program
• A letter from the AFMC corporate medical director highlighting significant issues or trends in the data
• Findings of a special study such as: PCP change rates, pharmacy utilization trends or HEDIS measures

Utilizing the report data we track, visit, and educate providers who are identified as having comparatively high costs and/or utilization over several quarters. The total annual costs of recipients in a given caseload are risk adjusted to enhance the accuracy of comparative performance measures.

To increase reliance on generic medications when their use would not compromise the level of care, we provide the pharmacy cost comparison chart comparing the cost of some commonly prescribed medications and their generic equivalents.

View a sample physician-specific PCP profile report

What physicians can do with their report:

• Review data in the report to determine how their patient panel compares to statewide averages for cost and utilization per enrollee per month
• Request detail reports to review specific information on each paid claim summarized in the PCP Profile
• Request visits from the MMCS provider relations staff if there are further questions about the data in the report or ways to achieve higher efficiency.

Primary Care Physician Profile Sample Report

View PDF of Sample PCP Report

Request visits from the MMCS provider relations staff if there are further questions about the data in the report or ways to achieve higher efficiency.