ahcccs update. prop 204 + expansion 2 reaching across arizona to provide comprehensive quality...
TRANSCRIPT
AHCCCS Update
2
Prop 204 + Expansion
Reaching across Arizona to provide comprehensive quality health care for those in need
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
3
Expansion Population
Reaching across Arizona to provide comprehensive quality health care for those in need
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14Jul-1
4
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15Jul-1
5
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
May-16
Jun-16 -
10,000
20,000
30,000
40,000
50,000
60,000
70,000
AHCCCS ADULT EXPANSION POPULATION
Actual FY15 Forecast FY16 Forecast
4
No Response Redes - % of Total
Dec Jan Feb March April May June0
5
10
15
20
25
30
35
40
45
Reaching across Arizona to provide comprehensive quality health care for those in need
5
Prop 204 and Expansion Ages (CY 14)
Reaching across Arizona to provide comprehensive quality health care for those in need
Ages 0-4
Ages 5-9
Ages 10-14
Ages 15-19
Ages 20-24
Ages 25-29
Ages 30-34
Ages 35-39
Ages 40-44
Ages 45-49
Ages 50-54
Ages 55-59
Ages 60-64
Ages 65-69
Ages 70-74
Ages 75-79
Ages 80-84
Ages 85-89
Ages 90-94
Ages 95-99
Ages 100-104
Ages 105-109
Ages 110-114
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Prop 204 ParentsProp 204 Childless AdultsProp 204 SSIACA Newly Eligible Adults
6
GAO Medicaid Spending ReportDuals excluded – 2009-2011 (No Expansion)
• 1% of Population = 25% of spend
• 5% = 50% of spend
• 25%= 75% of spend
• Bottom 50% = 8% of spend
Reaching across Arizona to provide comprehensive quality health care for those in need
7
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
Reaching across Arizona to provide comprehensive quality health care for those in need
8
1332 Waivers• Part of ACA
• Allows States to waive1. QHP and EHB Statutes2. Marketplace Requirements 3. Tax Credits – QHP Cost Sharing –
• Requires Legislation
• Statutory Principleso At least as comprehensive benefits –
Affordable – offered to comparable number of residents
Reaching across Arizona to provide comprehensive quality health care for those in need
9
Overkill – by Atul Gwande• Medicare Study on 26 low/no value Tests – 25-
42% of Population received
• Example of Walmart Spine Centers of Excellence
• Transparency McAllen Texas - $3,000 per person reduction
• Premise – Unnecessary Care crowding out important care
• 20% of physicians in alternative payment models
• Focus on importance of primary care and PCMH
Reaching across Arizona to provide comprehensive quality health care for those in need
10
DD Acute RFI Questions
1. BH Integration
2. Support Payment Reform
3. Geographic Coverage
4. CRS Integration
Long Term Future Discussions (Not for current RFI/RFP) – Fully Integrated Opportunities
Reaching across Arizona to provide comprehensive quality health care for those in need
11
Administrative Simplification
Reaching across Arizona to provide comprehensive quality health care for those in need
12
AHCCCS – DBHS Merger• Staffing
o Communicated with over 50 DBHS Staff about transitioning to AHCCCS
o Goal of developing new Organization by 7-1-15
• Other Areas of Focuso ITo Legalo Grants o Stakeholder Communication Reaching across Arizona to provide comprehensive
quality health care for those in need
13
Provider Rates• 230 pages of public comments
• Wide variety of provider types
• Timelineo Week of June 8th - Publish Draft Rates o June 17th – Tribal Consultationo July 1st – Submit SPAs to CMSo October 1st - Implement
Reaching across Arizona to provide comprehensive quality health care for those in need
14
GMH/SA Duals Transition• May 28th Plan Specific Meetings
1. Network Status – Analysis – Contracting
2. Staffing
3. Data transfers – AHCCCS historical data – DEF Files
4. High risk populations
5. Provider – Member CommunicationReaching across Arizona to provide comprehensive
quality health care for those in need
15
Legislative Implementation Update• Teledentistry
• Orthotics
• MCO Prescription Drug Utilization Management
• MCO ED Utilization Management
• AHCCCS Waiver Submittal Requirementso Work – 5 Year limits – Cost Sharing
• NF Assessment ContinuationReaching across Arizona to provide comprehensive
quality health care for those in need