CYE 15 Payment Reform Initiatives

Acute Care• Continue CYE 14 model with 1% capitation withhold and

the following changes:– Minimum 10% of the value of total payments under all

contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

– AHCCCS considering limiting portion of shared savings with owner systems – 33% of total maximum?

– AHCCCS considering adding geographic requirements – e.g. 80% maximum in any one GSA for multiple GSA plans?

CYE 15 Payment Reform Initiatives

ALTCS EPD• Implement initiative similar to Acute Care CYE 14 model:

– Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted• Minimum 2% of total Acute Care service payments• Minimum 2% of total LTC service payments• Remaining 3% of total spend at MCO discretion

CYE 15 Payment Reform Initiatives

ALTCS EPD– Minimum 1.5% of Medicare DSNP total payments

under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

– 1% capitation withhold • Distribution based on existing performance

measures • Would prefer mix of Acute Care and LTC services • Input on performance measures welcome

CYE 15 Payment Reform Initiatives

ALTCS DDD• LTC Services

‒ DES/DDD submit plan regarding value-based purchasing to AHCCCS by April 2015 for CYE 16 implementation

• Acute Care Services‒ Implement initiative similar to Acute Care CYE 14 model:• Minimum 5% of the value of total payments under all

contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts counted

• Consider 1% capitation withhold• Input on performance measures welcome

CYE 15 Payment Reform Initiatives

CRS• Implement initiative similar to Acute Care CYE 14 model:

–Minimum 5% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted– No capitation withhold due to single Contractor– Consider sanction for non-compliance

CYE 15 Payment Reform Initiatives

BHS• Implement initiative for integrated RBHA

–Minimum 1% of the value of total payments under all contracts with providers must be governed by shared-savings arrangements – NO sub-cap contracts/block purchasing counted– No capitation withhold due to single Integrated RBHA– Consider sanction for non-compliance