Magellan of Arizona Provider CEO

Meeting

September 30, 2009

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Welcome and Overview Review of Progress in SFY 2009 Shared Challenges SFY 2009 and 2010 Provider Contracting Non-Title Funding Data Integrity Quality of Care Initiatives and Effective

Management

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Transition of Service to Community Control ◦ PNO Development and Clinic Transitions ◦ UPC Transition to Private Ownership ◦ Crisis Safety Net (awarded crisis navigator funding to

NOVA, Community Bridges, Valle Del Sol, and Empact) Adult Clinic Vacancy Rate at a Historical Low of

98.75% Peer and Family Mentor Roles have increased by

33% from 36(Sept. 07) to 48 currently Use of Clinic and PNO Outcomes Dashboard and

Productivity Report

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Tribal relations ◦ Fort McDowell tribe agreement for crisis services ◦ Collaborative relationships established with San Lucy and Salt River Pima/

Maricopa tribes In FY09 we have added: ◦ 6 Outpatient Clinics ◦ 1 Community Service Agency ◦ 4 Independent Practitioners ◦ 3 Level I Facilities ◦ 3 Level II Facilities ◦ 1 Habilitation Provider

Transitioned DBT counseling provided through DCCs to a community provider

Transitioned the Evaluation team to a community provider

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Children’s High Needs Case Management Staffing at 100% - growth from 70FTEs (June 08) to 191FTEs (June 09)

Children’s Out-of-Home utilization has decreased from 2% to 1% ◦ Level I RTC: from 147(Sept 07) to 77(Sept 09) ◦ Out-of-State: from high of 25(Sept 07) to 7(Sept 09) ◦ Level III: from high of 29(Sept 07) to 13(Sept 09) ◦ Overall: 376/~16,000 enrolled (Sept 07) to 377/~22,000

enrolled (Sept 09) Child and Family Team Implementation increased

almost 300% from 4,942 (Sept 07) functioning CFTs to 14,616 (August 09)

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Transition to Adulthood Pilot implementing the TIP model into policy and practice was completed for youth determined SMI ◦ Served 120 youth Helped 20 of the 120 to enroll in College

◦ FY10 expanded to include GMH/SA Three Transition Facilitation Agencies Five Support Service Agencies

Expanded Generalist Direct Support Services – Known as Meet Me Where I Am (MMWIA) ◦ 3 Providers to 6 Providers ◦ Implemented Quality Practice Review ◦ Completed 3 provider readiness reviews to assess and

prepare for possible expansion

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State fiscal crisis Budget reductions in 2009 ◦ $11M with only $1.5m passed to providers

The system spent $24m in uncompensated care Implemented strategies to address reductions

Limited COE and stopped COT for NT, NSMI Single Case Agreement reductions Began the NT to Title screening initiative with PNOs Stopped hospital Rapid Response for NT, NSMI Implemented crisis safety net only benefits for NT, NSMI Implemented generic formulary for NT recipients

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State Funding Reductions in SFY 2010 ◦ Annualized SFY 2009 reductions - $9m ◦ Expected additional $5.5-6m in NT SMI reductions ◦ More reductions can be expected in January, 2010 ◦ However, Title XIX membership growth means more

funding available for the system Steps to address living within available funding: ◦ Collaborative provider workgroup process to prioritize

services: Present service prioritizations to DBHS Funding services within available State allocations

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Steps to address living within available funding (continued): ◦ Improving data accuracy to maximize NT funds Assuring all recipients are in the right eligibility buckets

◦ Other initiatives include: Working to implement residential pre-auth & concurrent review Implementing 10 day crisis pharmacy benefit for NT/NSMI Full implementation of screening NT recipients for Title status

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NON TITLE SERVICE REVENUE AND EXPENDITURES (In Thousands)

$-

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

2009 2010

FISCAL YEAR

DOLL

ARS

Service RevenueService Expenditures

excludes potential $6m reduction

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Amount SMI $ 16.2 Children 7.6 GMHSA 3.2 Total $ 27.0

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FY10 Funding/Rate Priorities: o Reconcile by funding silo for all providers except adult

PNOs and crisis services o Non-Title Funding within available resources o Implement a FFS model for Residential Services o Review of encounter values for quarterly recoupment,

withhold, or interim adjustment o 5% decrease in Fee-For-Service Rates consistent with

AHCCCS reductions o Equalize rates for comparable/similar services o Modified scopes of work based on provider, RBHA, and

stakeholder feedback o Establish outcome based contracting

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System Priorities: oAccess to Care oConsumer Operated/Delivered Services oMaintain a functioning crisis system oSub-Acute Expansion oLatino, African American, Native American

Initiatives oExpand services that promote recovery,

community integration and employment

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Bridge payments established to provide cash flow to block funded providers

Initial FY10 amendments allocated bridge funding through September 30, 2009

Providers who have signed and returned the initial FY10 amendment will receive correspondence indicating extension of bridge payment through October 31, 2009

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Funding models FY10 contracts have been developed

Rate schedules for FY10 have been completed and are under review at ADHS/DBHS

Provider performance profiles are being distributed the 1st week of October

Amendments set to begin delivery to providers in mid - October

FY10 payment adjustments will not be completed until final contract signature and increase could be jeopardized by delayed execution

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Children’s Work Group

Adult Core Services

Adult Crisis Services

Adult Inpatient Services

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Guiding Principles

•Preserve a crisis safety net available for all populations •Focus on programs that drive

community stabilization •Consider impact on health care

disparities and access to care – culturally competent outcomes •Align expectation and priority

initiatives •Consider collaborative agreements •Maximize those screened and

enrolled into entitlements

Outcomes

•Preserve family voice and participation •Establish a framework for the

system to maintain a core set of services throughout the year • Identify services that would be

provided based on available funding • Identify provider efficiencies and

consistent cost base services •Preserve services that lead to

community stabilization, success in school, family integration and decrease the need for detention •Enable the system to live within

the state appropriated funding allocation

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•Formulary Management ($200-500K) •Limit inpatient utilization to 3 days ($20K) •Room & Board DES ($200K) •Other Benefit Limitations

Children’s

•Prior authorization and/or cap number of sessions for certain services ($160) •Formulary Management •Transportation and flex funds

Adult Core

•Retain the crisis safety net as defined ($0)

Adult Crisis

•No longer pay for non-medically necessary NT inpatient days ($2-2.3m) •Review detention period payment for SMI ($1.6-2.3m)

Adult Inpatient

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Enrollment accuracy is crucial to system performance and efficiency

The system has seen great improvement in the integrity of the enrollment and eligibility data over the past two years

Issues still remain that are impacting funding and encounter reconciliation

Everyone has a part in timely and accurate enrollment information

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Open enrollment for individual’s who should be closed

New intakes with missing demographic

information

Duplicate enrollments Partial matches

Management of Title 19 eligibility •Timely screening •Application processing and tracking •Reapplication monitoring and follow up

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Four Clinical Initiatives Clinical Case Management Model ◦ Moving beyond brokering care

Suicide Prevention and Intervention ◦ Helping to detect suicidal risk and how to talk

about it Crisis Planning ◦ Proactive and reactive

Health/Wellness and Life Expectancy ◦ Integrating healthy bodies with healthy minds

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Evolution from coordination of care to clinical model ◦ Move beyond “brokering” care ◦ Outcomes 360 ◦ Provider integration / continuum of care

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Lowering Arizona’s suicide rate ◦ Arizona ranks seventh in the nation for suicide (2007) ◦ Awareness Suicide prevention information packets

◦ Education and training: ASIST suicide prevention program Helps case managers and others who interact with

those contemplating suicide detect / address suicidal behaviors

Teaches them how to talk about suicide ◦ Community action Suicide prevention task force

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Individual Service Plan ◦ Created with recipient and case manager ◦ Proactive plan: define, spot signs to avoid

a crisis ◦ Reactive plan: response steps to defuse a

crisis; “psychiatric care directive” jointly developed with each person under care ◦ Record and share updates with the entire

treatment team

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Recipient longevity ◦ Life span of SMI vs. general population ◦ Programs to integrate healthy bodies and minds Passport to Care EnhanceMedSM

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Dashboards driving performance improvement ◦ Adult PNOs and Clinics

◦ Children’s PNOs and QSPs Functional Outcomes Staffing Clinical Quality Outcomes Child & Family Team Practice Coordination and Continuity Service Maximization

◦ GMH/SA Providers ◦ Crisis Providers

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