ahcccs update - university of arizona...30 years of medicaid innovation our first care is your...
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“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
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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.”
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS Childless Adult Population
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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0
50,000
100,000
150,000
200,000
250,000
300,000
Actual Forecast
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS Adult Expansion
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Forecast
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
AHCCCS projected cumulative growth
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Percent of Gross Domestic Product Source: Congressional Budget Office, The Long-Term Budget Outlook, June 2010, revised August 2010
15 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
What’s Wrong With This Picture?
16 30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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.
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Payment Modernization Progression AHCCCS is pursuing various strategies to
move program along continuum
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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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
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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Payment Modernization
Transparency
Align Incentives/
Value Based Purchasing
Learning Culture
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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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“Reaching across Arizona to provide comprehensive quality health care for those in need”
Maricopa Integration for Members with Serious Mental Illness
Single MCO
Medicaid Behavioral
Health
Medicaid Physical Health
Medicare D-SNP
Housing & Employment
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
30 Years of Medicaid Innovation Our first care is your health care Arizona Health Care Cost Containment System
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“Reaching across Arizona to provide comprehensive quality health care for those in need”
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
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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