The Arkansas Health Network (AHN) is the first clinically integrated network to achieve dual URAC accreditations for clinical integration and employer-based population health. Bob Sarkar, M.B.A., who has been president and CEO of AHN since 2015, recently spoke with Healthcare Innovation about the evolution and growth of the network and its participation in value-based care models.
HCI: Could you talk about your role with the Arkansas Health Network over the last several years?
Sarkar: I joined Arkansas Health Network in 2015 when it was in its infancy stage. I was the first full-time employee, so you could say that it's kind of my baby. Today we have close to 50 employees.
At the time I joined, we were managing a Medicare Shared Savings ACO and had just done one year with a network of close to 1,100 providers. We were managing close to 40,000 value-based care lives. We were predominantly a Central Arkansas-focused network. Today we are Arkansas' largest provider-led clinically integrated network. We are a subsidiary of CommonSpirit Health, which is the largest nonprofit parochial health system in the country, operating in 24 states.
HCI: You mentioned being Central Arkansas-focused initially and having 1,100 providers. Are you now statewide and with a lot more clinicians?
Sarkar: Absolutely, we are statewide. Arkansas Health Network has just over 3,700 providers. We have several partnerships with health systems. We have a strategic partnership that we have formed just to manage self-funded commercial employers with two other clinically integrated networks — Arkansas Children's Care Network, and NextHealth Integrated Network. That collaboration is called AR NetPartners. We also have 27 hospitals and 25 skilled nursing facilities in our network.
HCI: What is the significance of achieving dual URAC [Utilization Review Accreditation Commission] accreditations for clinical integration and employer-based population health?
Sarkar: Functionally, no one has been doing what we are doing — a synergy between an adult-focused clinical network like us with a pediatric CIN and going to the market to help bring costs down and improving quality. URAC had just started their accreditation in employer-based population health, and we were the first to go there because we wanted to ensure that we get the objective credibility in brokers’ and employers’ mind and in the minds of the providers who are partners across the state, and also, of course, patients and consumers. We went through the journey for a year and a half. We had a tabletop assessment by URAC and we got 100 percent on it. Then they came here on site to do an entire-day survey, and we got 100 out of 100. That became very relevant to us because we got the approvals from a third party to say that what we are doing is on the right track, and we continue to learn, and we plan to share those learnings.
HCI: The health IT landscape has changed quite a bit since 2015. I imagine you have lots of different EHRs in the network. Can you talk about how you cope with that and how you do analytics?
Sarkar: We are a population health management company. It's like a three-legged stool. There are three things that you need for effective and efficient population health management. The first is a robust provider network across the geography or across specialties and subspecialties that we will be managing. The second thing is a multidisciplinary care management team. Number three — and we have partnered with a company called Innovaccer on this — is a next-generation analytics and IT platform to integrate not just adjudicated claims data but also clinical data from hospital and ambulatory EMRs.
Innovaccer helps us do proactive care to head off claims and as a result see efficiencies. In our URAC journey, one of the key components was what kind of technology we have. How are we integrating new EMR data? How are we integrating claims data? Innovaccer comes into play because we have 35 EMRs that could be integrating into our presence in the state. Innovaccer plays a vital role in helping our population health management team to identify proactively who is already high risk and who could be rising risk to intervene proactively.
HCI: What has been your experience in the MSSP ACO program over the last several years?
Sarkar: Initially we were taking upside risk; then with maturity we started taking upside and downside risk. And now we are in an enhanced pathway taking the highest level of risk, 75 percent upside risk, 40 percent downside risk. For the last five years, we have been saving a significant amount of money for CMS, and we have been blessed to have received shared savings from CMS. Patient attribution is a major challenge and getting clean data from CMS at the right time is a challenge that continues. A couple of large health systems and providers are joining us to be part of our MSSP ACO. But we have been diligent to ensure that their performances do not dilute ours. So our assessments and our litmus tests, so to speak, for incorporating them are very high.
HCI: What are some things your organization has seen coming out of the pandemic?
Sarkar: What we have seen is a lot of increase in the need for behavioral healthcare. We are putting appropriate strategic resources in place, whether it is addiction centers or other outpatient resources and integrated behavioral health and primary care. We are seeing behavioral health issues becoming more acute. Plus, there was a shortage of behavioral providers already. It was a chronic issue already in the industry and it has been aggravated quite a bit. We are all trying to focus our energy into that area.
Another area that we are seeing involves the social determinants of health issues — housing, transportation, and nutrition. We are applying for grants to partner with providers and to partner with the federal government and state government in those areas, too.
