AHCCCS Update

2

• 70 m • Lives Covered

Medicaid 50th Anniversary

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• 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

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4

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

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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

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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

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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

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Continuum of Integration

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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.

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Systems Focus

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9,000 4,000

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Pima County Jail Medicaid Status

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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

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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

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AHCCCS Contract Timeline

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Children in Foster Care PMPM

CMDP Non CMDP0

200

400

600

800

1000

1200

1400

PHBH

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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