AHCCCS Update
AHCCCS Care Delivery System
2 Reaching across Arizona to provide comprehensive quality health care for those in need
AHCCCS Population as of July 1, 1985 – 2015
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
3
.
Reaching across Arizona to provide comprehensive quality health care for those in need
AIHP Enrollment
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-
20,000
40,000
60,000
80,000
100,000
120,000
Kaiser Medicaid Survey
• 37 states real time eligibility
• 39 allow online account to manage
• 34 states auto renewal
• 10 of 26 reported >50%
• AZ 25-50%
• 18 States integrated 1 non health
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Percent of Auto-Renewals
0
5
10
15
20
25
30
35
40
45
50
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7
100% Federal Indian Health Services & Tribal Facility Payments (In Millions)
0
100
200
300
400
500
600
FY04
FY05 FY06
FY07
FY08
FY09
FY10
FY11
FY12
FY13
FY14
FY15
AIHP Payments for Services (in millions)
0
100
200
300
400
500
600
700
800
900
1000
FY 13 FY 14 FY 15
Non-Tribal
Uncomp
Services
8 Reaching across Arizona to provide comprehensive quality health care for those in need
18-64 Uninsured Nationally
Reaching across Arizona to provide comprehensive quality health care for those in need
9
Insurance coverage by Economic Status
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10
2015 Accomplishments • BHS/AHCCCS Merger
• Greater AZ RBHAs
• Duals BH Integration
• CRN – SMI Determination
• Avoided 5% Provider Rate Reduction
• Moved DES Medicaid Eligibility to HEAPlus
• AIHP Care Coordination - >80 members
• Successfully Transitioned New Governor
11 Reaching across Arizona to provide comprehensive quality health care for those in need
2016 Opportunities • 7-1-16 – Complete Merger – Contracts – TRBHA IGAs
• 10-1-16 – New 1115 Waiver – Tribal Issues
• ALTCS EPD Procurement
• DD Acute Procurement – BH Integration
• Integration 2.0 Planning – Stakeholders
• Justice System Transitions
• Value Based Purchasing - DSRIP
• Health Information Exchange
• Hospital Assessment Case 12 Reaching across Arizona to provide comprehensive
quality health care for those in need
Percentage Change in Federal Funding (2008-2014)
-20
-10
0
10
20
30
40
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Medicaid Other Health Income Security
Transportation Education
Everything Else
Delivery System Initiatives
0 10 20 30 40
MLTSS
Duals Demo
DSNP Alignment
Managed BH
BH PH Integration
Planning
Implementing
Implemented
14 Reaching across Arizona to provide comprehensive quality health care for those in need
GAO - Conditions of Members (%) Condition Asthma Diabetes HIV/AIDS MH SUD Delivery LTC None
Asthma 24.5 3.9 65.1 29.1 6.5 7.3 17
Diabetes 18.5 2.6 52.4 23.9 3.1 12.7 29.7
HIV/AIDS 17.9 15.6 48.1 39.4 2.1 7.2 29
MH 17.6 18.7 2.8 26.7 4.0 11.9 42.9
SUD 20.8 22.6 6.0 70.8 4.5 10.2 15.6
Delivery 9.3 5.9 0.7 21.3 9.0 0.5 66
LTC 12.5 28.6 2.8 74.7 24.4 0.6 14.1
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Fragmented Delivery System
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Economic Impact of Integration (Milliman)
• Costs for chronic medical conditions for those with co-occurring MH/SA are 2 to 3X
• Diabetes PMPM
o w/o MH/SA - $1,068 – w/ $2,368
• Total Opportunities
o Medicaid $100 B (Pre-Expansion)
o Medicare $30 B
o Commercial $162 B
o Total Achievable $26-48 B 17 Reaching across Arizona to provide comprehensive
quality health care for those in need
A standard Framework for Levels of Integrated Care
18 Reaching across Arizona to provide comprehensive quality health care for those in need
COORDINATED CO-LOCATED INTEGRATED
LEVEL 1
Minimal
Collaboration
LEVEL 2
Basic Collaboration
At a Distance
Level 3
Basic Collaboration
Onsite
LEVEL 4
Close Collaboration
Onsite with Some
Systems Integrated
LEVEL 5
Close Collaboration
Approaching an
Integrated Practice
LEVEL 6
Full Collaboration in
Transformed/Merged
Integrated Practice
Tighter Communications
Increased Interoperability
One Care Plan: One Care Team;
Shared Risk/Reward “Sharing the Care”
“At a Distance Collaboration”
Social Determinants - Opportunities
19 Reaching across Arizona to provide comprehensive quality health care for those in need
Housing Funding for Individuals with Serious Mental Illness (in millions)
0
5
10
15
20
25
FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2015
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21
Systems Focus
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9,000 4,000
Children in Foster Care PMPM
0
200
400
600
800
1000
1200
1400
CMDP Non CMDP
PH
BH
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Administrative Simplification
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Merger Status
• Approximately 95 of 100 staff re-located
• Working to have new TRBHA IGAs in place
• Working with stakeholders to simplify Episode of Care requirements
• Working on transition of IT system
• Working to have new contracts/agreements in place
• Transitioning Grants and SSA authority
o 24 Reaching across Arizona to provide comprehensive
quality health care for those in need
AHCCCS Strategic Plan
Reaching Across Arizona to Provide Comprehensive, Quality Health Care for Those in Need
Reduce
fragmentation in healthcare delivery
to develop an integrated system
of healthcare
Bend the cost curve while
improving the member’s health
outcomes
Pursue continuous quality
improvement
Maintain core organizational
capacity, infrastructure and
workforce.
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Strategies to Address Sustainability
1. System Design Matters – Most Complex Populations = Most Complex System
1. Dual Eligible Members
2. Individuals with Serious Mental Illness
3. Children With Special Needs
4. Individuals with Disabilities
2. Better Align Incentives – Value Based Purchasing
26 Reaching across Arizona to provide comprehensive quality health care for those in need
Integration Efforts
1. 2013 – 17,000 CRS Kids
2. 2014 – 20,000 Individuals with SMI – Maricopa
3. 2015 – 19,000 Individuals with SMI – Greater AZ
4. 2015 – 80,000 dual eligible members
5. Future Possibilities
1. 2017 – 29,000 members with DD – BH & PH
2. 2018 – 34,000 Children with Autism or at risk
3. 2018 or future date – Adults GMH/SA
27 Reaching across Arizona to provide comprehensive quality health care for those in need
DSRIP Projects
1. American Indian Care Management Collaboratives
2. Physical Health - Behavioral Health integration
a. Adults
b. Children
3. Justice System Transitions
28 Reaching across Arizona to provide comprehensive quality health care for those in need
CMC DSRIP Framework
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CMC DSRIP Projects
Project 1 – Care Management Collaboration Formation
1. Join CMC through executing MOU – One Time Payment
2. Regularly participate in CMC meetings with appropriate staff – ongoing
30 Reaching across Arizona to provide comprehensive quality health care for those in need
CMC DSRIP Projects Project 2 – Care Management Execution
1. Regular Care Management staffings of members with CMC and other providers as appropriate – ongoing
2. Establishment and Maintain Attribution Model for Complex Members – ongoing
3. Complex Member Engagement – Transition to Medical Home Waiver PMPM - onetime
4. Establish and Execute Transition Planning for IP – Justice System - Crisis - ongoing
31 Reaching across Arizona to provide comprehensive
quality health care for those in need
CMC DSRIP Projects Project 3 Data Infrastructure
1. IHS/Tribal 638 Providers submit more robust claim detail – onetime
2. Dedicated support of CMC Data analytics tools - ongoing
3. Ability to identify complex members accessing internal/external delivery system - ongoing
4. AZHEC Connectivity – receive data & push data- onetime each
5. Register and use CSPMP - ongoing 32 Reaching across Arizona to provide comprehensive
quality health care for those in need
CMC DSRIP Aligns and Complements Medical Home Waiver • 1115 waiver proposal includes Medical Home waiver
which would pay a PMPM to qualifying facilities
• Current IHS/tribal 638 workgroup is working to update formal proposal
• DSRIP is focused on building care coordination and care management across system (IHS/tribal 638 and non-IHS/tribal 638 providers organizations)
• Medical Home waiver is focused on building internal facility/organizational capacity
33 Reaching across Arizona to provide comprehensive quality health care for those in need
The Network – Growth All Participants
34
-
10
20
30
40
50
60
70
80
90
100
2011 YE2012 YE
2013 YE2014 YE
2015 YE2016 YTD
11 23 33
33
79 91
Nu
mb
er o
f Pa
rtic
ipan
ts
88% of the 2015/2016 growth occurred after the implementation of the new HIE Infrastructure.
DSRIP Next Steps
• March 17th – Met with Indian Health Medical Home workgroup
• March 23 – Tribal Consultation
• April 7– review DSRIP concepts with CMS
• Early May – post DSRIP waiver for public comment
• Summer 2016 – negotiate with CMS
35 Reaching across Arizona to provide comprehensive quality health care for those in need
AHCCCS Supporting Integration • Rate Adjustments
o 2015 - BH IP 19.6% increase
o 2016 - Select OP service
o 2016 – Integrated providers PH bump
• Restructuring TRBHA Agreements
o Reduce Requirements – focus on care coordination – no network -
• Providing support to tribes through efforts to partner with DFSM
• Working to get better data - NDC
36 Reaching across Arizona to provide comprehensive
quality health care for those in need
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