ahcccs update - university of arizona...30 years of medicaid innovation our first care is your...

“Reaching across Arizona to provide comprehensive quality health care for those in need”

AHCCCS Update

30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System



2


Policy Options Options Lives

covered GF Impact (FY 14-16)

Federal $ available

Prop 204 Vote Honored

Governor’s Proposal

300,000 $(100) m savings

$4.1 billion Yes

Continued Freeze (assume state only)

63,000 and shrinking

$850 m plus cost

$0 No

Terminate Coverage 1-1-14

0 (63,000 lose coverage)

$0 $0 No


3


Final Legislation Authorizes Prop 204 Restoration and

Expansion Provides AHCCCS Director with ability to

levy an assessment against hospitals – includes ability to exempt

Includes circuit breakers Governor had requested in case federal funding is reduced

Restores Well-exams 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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Budget and Legislation Assumes 3% capitation rate for AHCCCS Assumes 3% provider rate increase for BH (10-1) and DD

providers 7-1-13 Increases ambulance rates beginning 10-1-14 Repeals HCG 1-1-14 – stops enrollment 8-1-13 Increases cost sharing above federal limits Did not provide for general rate increases AHCCCS continued for 10 years Legislature authorized APR-DRG 10-1-14


5


AHCCCS Reports 12/1/13 - Non-emergency use of the ED 12/31/13 – Air Ambulance – 5 year history and consistency

with rules 1/1/14 – Hospital Transparency – Charge-master Report –

recommendations 10/1/13 - Hospital Uncompensated Costs – change in uncomp

costs and profitability 8/1/14 – Hospital Assessment paid – coverage 10/1/14 – Legislative circuit breaker and outcomes study

committee – impact of decreased federal funds


6


Hospital Assessment Workgroup AHCCCS working with Navigant Projected need of $75 m in FY 2014 - $255 m FY 15 Established hospital workgroup Major decisions include –

Rate basis – Time period for rates – payment timing – transparency reporting - exemptions

Working to establish model that minimizes systems negatively impacted

Proposed Model can be found on AHCCCS website Taking comments until September 4 – To CMS mid-Sept. Final Rule out in November with 30 day comment


7


Phase II Lawsuits Referral – Constitution exempts laws necessary

for the support and maintenance of the departments of the state government”

Prop 108 – does not apply to “fees and assessments that are authorized by statute, but are not prescribed by formula, amount or limit, and are set by a state officer or agency.”


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0%

50%

100%

150%

200%

Infants (0-1)

Children (1-5)

Children (6-19)

Pregnant Women

Parents Aged, Blind and Disabled

Childless Adults*

Exchange Subsidies

Full Expansion

Healthcare Reform Mandatory

Prop 204 Expanded Coverage

State Expanded Coverage (Non-Prop 204)

*Currently frozen

~ ~ ~ ~ ~ ~ Medicaid and ACA Populations

67% 67% 67% 67% 67% 67% 85%

100%

100%

Medicare

400%

100-133% FPL Estimated 57,000 to enroll

Percentage of costs paid by federal government

9 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System


AHCCCS Childless Adult Population


10

0

50,000

100,000

150,000

200,000

250,000

300,000

Actual Forecast


AHCCCS Adult Expansion


11

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Forecast


AHCCCS projected cumulative growth


12

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000


Health E Arizona Plus On schedule to bring up on 10-1-13 Considerable challenges remain Lack of live testing to federal marketplace CMS just finalized regulations Efforts to consolidate Medicaid call center

support Training materials for staff and public Size – Scope – Timeframe – issues unknown


13


Regardless of ACA Decisions- Unsustainable System Institute of Medicine - $750 Billion in “Waste”

$210 B Unnecessary Procedures $130 B Inefficient Care $190 B Excess Admin $105 B Inflated Prices $55 B Prevention Failures $75 B Fraud

IOM Solutions – Science and Informatics – Engage and Empower Patients – Align Incentives – Transparency – Culture of Leadership and Learning


14


Percent of Gross Domestic Product Source: Congressional Budget Office, The Long-Term Budget Outlook, June 2010, revised August 2010



What’s Wrong With This Picture?



U.S. Healthcare System System – an assemblage or combination of things or parts forming a complex or unitary whole Care delivery has become increasingly fragmented, leading to

coordination and communication challenges for patients and clinicians.

Improved patient engagement is associated with better patient experience, health, and quality of life and better economic outcomes, yet patient and family participation in care remains limited.

The prevailing approach to paying for health care, based predominantly on individual services and products, encourages wasteful and ineffective care.


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Create care

Reaching Across Arizona to Provide Comprehensive, Quality Health Care for Those in Need

Pursue continuous quality improvement

Reduce fragmentation in healthcare delivery

to develop an integrated system of

healthcare

Maintain core organizational

capacity, infrastructure and workforce

Achieve Program Integrity Plan goals

Establish Payment Modernization

stakeholder input opportunities

Promote and evaluate access to

care

Improve health outcomes for

integrated populations

Leverage American Indian care

management program to improve

health outcomes

Align and integrate model for SMI, CRS

and dual-eligible members

Build care coordination

opportunities in the system

Leverage HIT investments to

create more data flow in healthcare delivery system

Deploy electronic solutions to reduce healthcare admin

burden

Ensure talent infrastructure

remains in place

Strengthen information system

security and compliance

Maintain IT network infrastructure

Improve accuracy and efficiency of

eligibility determination process for

Medicaid and CHIP

Achieve statistically significant

improvements on Contractor PIPs

Achieve statistically significant

improvements on performance

measures

Build analytics into actionable solutions

Bend the cost curve while improving the

member’s health outcomes

Implement shared savings

requirements for ALTCS and Acute Care Contractors

Modernize hospital payments to better

align incentives, increase efficiency and improve quality

of care

Commit Executive level resources to

substantive payment modernization


Payment Modernization Progression AHCCCS is pursuing various strategies to

move program along continuum


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Capitation + PBC

Performance- based Programs

Centers of Excellence

Accountable Care Programs

Shared Risk

Shared Savings

Bundled/ Episode

Payments

Performance- Based

Contracts (PBC)

Primary Care

Incentives

Fee-for- Service



20

Payment Modernization

Transparency

Align Incentives/

Value Based Purchasing

Learning Culture


AHCCCS 10-1-13 Transitions Roughly 165,000 members switching plans Every county impacted except Maricopa Letters start going out to members in July Plans will be transitioning relevant data to receiving

plans for care management AHCCCS currently conducting readiness reviews on

HealthNet and MCOs in new GSAs CRS - AHCCCS working closely with United on

new integrated plan – public forums – readiness etc. 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System

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Maricopa Integration for Members with Serious Mental Illness

Single MCO

Medicaid Behavioral

Health

Medicaid Physical Health

Medicare D-SNP

Housing & Employment


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Maricopa RBHA Transition March – Mercy Maricopa Integrated Care awarded Maricopa

RBHA contract Magellan continues to protest award to MMIC 5-21 Stay issued by ADOA on transition related activity September hearing date set for OAH DHS has stated that given the stay and this timeframe October

1st is not achievable AHCCCS working with DHS on Plan B – current structure –

updating contracts/cap rates Stay Tuned – Starting conversation for Greater AZ 10-1-15


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AHCCCS Staffing Levels

800

900

1000

1100

1200

1300

1400

1500

Jan-07

Apr-07

Jul-07

Oct-07

Jan-08

Apr-08

Jul-08

Oct-08

Jan-09

Apr-09

Jul-09

Oct-09

Jan-10

Apr-10

Jul-10

Oct-10

Jan-11

Apr-11

Jul-11

Oct-11

Jan-12

Apr-12

Jul-12

Employees


AHCCCS Update�Slide Number 2Policy OptionsFinal LegislationBudget and LegislationAHCCCS ReportsHospital Assessment WorkgroupPhase II Medicaid and ACA PopulationsAHCCCS Childless Adult PopulationAHCCCS Adult Expansion AHCCCS projected cumulative growthHealth E Arizona PlusRegardless of ACA Decisions- Unsustainable System�Percent of Gross Domestic Product�Source: Congressional Budget Office, The Long-Term Budget Outlook, June 2010, revised August 2010What’s Wrong With This Picture?U.S. Healthcare System Slide Number 18Payment Modernization ProgressionSlide Number 20AHCCCS 10-1-13 TransitionsMaricopa Integration for Members with Serious Mental Illness Maricopa RBHA Transition AHCCCS Staffing Levels

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