AHCCCS Update. 2 70 m Lives Covered Medicaid 50 th Anniversary Reaching across Arizona to provide...
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Transcript of AHCCCS Update. 2 70 m Lives Covered Medicaid 50 th Anniversary Reaching across Arizona to provide...
AHCCCS Update
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• 70 m • Lives Covered
Medicaid 50th Anniversary
Reaching across Arizona to provide comprehensive quality health care for those in need
• 1 in 3 • Kids (33 m)
• 1 in 7 • Elderly (6 m)
• 10 m • Disabled
• 25% • % of Total BH Spending• 38 States • Managed Care
• 500 B • Total Cost
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Federalism
Reaching across Arizona to provide comprehensive quality health care for those in need
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Proposed Managed Care Regs• 61 new Reporting requirements (Bloomberg)
• CMS Capacity to administer
• Increased Federal oversight = less Innovation
• Need Phase in of Requirements
• Strongly Oppose 14 day FFS
• Quality – Credential LTSS – Fed. PIP – Rating
• Finance – IMD – Cap Rates
• Grievance – Need member ok – no benefit guarantee
• Enrollment – support Rural – Provider term - open
Reaching across Arizona to provide comprehensive quality health care for those in need
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Population Changes
December 2013 Today Difference
Newly Eligible0
68,064 68,064
Restoration
67,770
283,659 215,889
All other
1,229,380 1,403,651 174,271
Total
1,297,150 1,755,374 458,224 Reaching across Arizona to provide comprehensive
quality health care for those in need
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Medicaid Restoration & Expansion
Reaching across Arizona to provide comprehensive quality health care for those in need
Jul-11
Oct-11
Jan-12
Apr-12
Jul-12
Oct-12
Jan-13
Apr-13
Jul-13
Oct-13
Jan-14
Apr-14
Jul-14
Oct-14
Jan-15
Apr-15
Jul-15
Oct-15
Jan-16
Apr-16
-
100,000
200,000
300,000
400,000
500,000
600,000
Actual FY15 Forecast
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Age Breakout
44%
50%
6%
0-1819-64>64
Reaching across Arizona to provide comprehensive quality health care for those in need
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Average Annual Capitation Growth
CYE '10 CYE'11 CYE '12 CYE'13 CYE'14 CYE 15 CYE 16-10
-8
-6
-4
-2
0
2
4
-2.45-4.2
-7.6
1.42.8 2 1.8
Reaching across Arizona to provide comprehensive quality health care for those in need
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FY 17 Budget Request• FY 16 Ending Balance $325 m
• Was projected to be ($132) m
• FY 17 AHCCCS Request + $114 m GF
• + $556 m for DBHS Transfer
• Cap Rates assumed 1.5% for FY 17
• Included request for ALTCS Dental
Reaching across Arizona to provide comprehensive quality health care for those in need
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Continuum of Integration
Reaching across Arizona to provide comprehensive quality health care for those in need
Screening
Navigators
Care & Case Managers
Colocation
Health Homes
System-Level Integration
Coordinated Care Colocated Care Integrated Care
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Milbank Integration Paper• Fully Integrated Care – All
providers function as a team to provide joint treatment planning and care. Single system treating whole person.
Reaching across Arizona to provide comprehensive quality health care for those in need
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Systems Focus
Reaching across Arizona to provide comprehensive quality health care for those in need
9,000 4,000
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Pima County Jail Medicaid Status
Reaching across Arizona to provide comprehensive quality health care for those in need
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1115 Waiver • New Waiver 10-1-16
• Public Process – meetings statewide
• Waiver provides flexibility for structure on mandatory managed care – benefits – etc…
• AHCCCS Choice Accountability Responsibility Engagement (CARE)o Exempts Children, Elderly, Disabled, Medically Frailo Includes copays and premiums/H.S.A
Timely Payments – Participate in AHCCCS Works – Meet healthy Arizona Targets
Reaching across Arizona to provide comprehensive quality health care for those in need
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Arizona’s Application• Arizona’s application for a new 5-year
waiver includes:o Part I: Governor Ducey’s vision to modernize
Medicaid: The AHCCCS CARE programo Part II: The Legislative Partnershipo Part III: DSRIP: Arizona’s Approacho Part IV: HCBS Final Ruleo Part V: American Indian Medical Homeo Part VI: Building Upon Past Successeso Part VII: Safety Net Care Pool
Reaching across Arizona to provide comprehensive quality health care for those in need
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AHCCCS Contract Timeline
Reaching across Arizona to provide comprehensive quality health care for those in need
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Children in Foster Care PMPM
CMDP Non CMDP0
200
400
600
800
1000
1200
1400
PHBH
Reaching across Arizona to provide comprehensive quality health care for those in need
DBHS/AHCCCS Merger Update• 115 BHS staff coming to AHCCCS
o 10 taking AHCCCS open positionso 18 moved over in July (DHCM, OIG, DFSM)
• Staff moving into the following divisions:
18Reaching across Arizona to provide comprehensive quality health care for those in need
Division New Staff Division New StaffDHCM 64 DBF 5ISD 6 OALS 10DFSM 5 OIG 1DHCAA (new) 24
DBHS/AHCCCS Merger Update• Anticipated timing of future moves
19Reaching across Arizona to provide comprehensive quality health care for those in need
Month/Year Staff
Aug 2015 8
Sept 2015 4
Oct 2015 22
Nov 2015 38
Jan 2016 11
June 2016 4
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And we are becoming more and more physically inactive
Women Men0
10
20
30
40
50
60
1911
5244
Population reporting no leisure-time physical activity (1988-1994; 2009-2010) Percent
1988-19942009-2010
Wom
en M
en P
erce
nt o
f Pop
ulati
on
Reaching across Arizona to provide comprehensive quality health care for those in need
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Prevalence of obesity in the U.S. on the Rise over the past two decades
19901991
19921993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20122013
20142015
0
5
10
15
20
25
30
35
Percentage of U.S. adults who are obese (2011; BRFSS Methodology)
Reaching across Arizona to provide comprehensive quality health care for those in need
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Whether self-reported or based on height and weight measures…
Reaching across Arizona to provide comprehensive quality health care for those in need
Korea
Norway Ita
ly
Switz
erland
Sweden
Netherla
ndsChile
Austria
Belgium
Denmark
France
Irelan
d
Slova
k Republic
Portuga
l
Finlan
d
German
yIsr
ael
Poland
Spain
Turke
y
Czech
Republic
Canad
a
Slove
nia
Estonia
Greece
Hungary
Australi
a
Icelan
d
United St
ates
0
5
10
15
20
25
30
Obese population, self-reported (2013 or nearest year) – Percent Total Population
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Traditional Amish farmers average1:
• 16,311 steps/day
• 41 hours/week of physical activity
• 4.5% obesity rate
Modern American workers average2:
• 5,117 steps/day
• 2 hours/week of physical activity3
• 34% obesity rate
Occupational activity is also declining
Reaching across Arizona to provide comprehensive quality health care for those in need
We have also cut back on physical activity required to get to and from work, “Today, a mere 2 percent of us walk to work…ten times less than fifty years ago.”4
Source: 1. Bassett et al. 2004. “Physical activity in an old order Amish community.” Journal of the American College of Sports Medicine. 36(1): 79-85; 2. Basset et al. 2010. “Pedometer-measured physical activity and health behaviors in U.S. adults.” Journal of the American College of Sports Medicine. 2010. 42(10): 1819-25; 3. Messer, A. 2012. “Americans fall short of federal exercise recommendations.” http://news.psu.edu/story/149052/2012/05/08/americans-fall-short-federal-exercise-recommendations (accessed November 11, 2014); 4. Levine, James and Selene Yeager. 2009. “Move a little, lose a lot: new N.E.A.T. science reveals how to be thinner, happier and smarter.” p.15. New York, NY: Crown Publishers.
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Talk Like TED1. Passion – contagious – inspiring – motivational
2. Tell a story – tool of persuasion – Ethos – Logos – Pathos – reach heart and mind
3. Have a conversation – voice – rate – volume – pitch – pause – gestures
4. Teach something new – learning is a joy – addictive
5. Deliver big moments – visuals – statistics
6. Lighten up – brain loves humor – improves morale –
7. Stick to 18 min – creativity thrives in constraints
8. Create Multi-sensory picture – recall 10% vs 65%
9. Stay in lane – be positive about speakingReaching across Arizona to provide comprehensive
quality health care for those in need
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Talk Like TED
Einstein – “If you can’t explain it simply you don’t know it well enough”
Lenardo de Vinci – “Simplicity is the ultimate sophistication”
Warren Buffet – “If you can’t communicate and talk to people and get across your ideas you are giving up your potential”
Reaching across Arizona to provide comprehensive quality health care for those in need