ahcccs update. ahcccs care delivery system 2 reaching across arizona to provide comprehensive...

AHCCCS Update

AHCCCS Care Delivery System

2Reaching across Arizona to provide comprehensive quality health care for those in need

Medicaid Restoration

Reaching across Arizona to provide comprehensive quality health care for those in need

3

12/1/2013 1/1/2015 Change

Prop 204 Restoration 67,770 275,743 207,973

Adult Expansion 0 37,369 37,369

KidsCare 46,761 1,665 -45,096

Family Planning 5,105 0 -5,105

AHCCCS for Families & Children (1931) 672,135 682,456 10,321

All Other 505,379 624,720 119,341

Total Enrollment 1,297,150 1,621,953 324,803

AHCCCS Enrollment Growth

Feb 1

Marc

h 1

April 1

May

1Ju

ne 1Ju

ly 1

August

1

September 1

October 1

November 1

December 1

January

1Fe

b 1

-20000-10000

01000020000300004000050000600007000080000

Enrollment Growth


Renewal Activity

Reaching across Arizona to provide comprehensive quality health care for those in need

5

Restoration/Expansion Actual to 2013 Estimates


4072540787

4084840909

4096941030

4109141153

4121441275

4134641407

4146841530

4159141652

4171141772

4183341895

4195642017

4207642137

4219842260

4232142382

4244242503

0

100,000

200,000

300,000

400,000

500,000

600,000

AHCCCS/DES Call Volume

January

Febru

ary

Marc

hApril

May

Ju

neJu

ly

August

September

October

November

December

January

0

50000

100000

150000

200000

250000

300000

350000


Impact of Enhanced Match (Millions)Funding Source for Adults 0-100%

FY 16 Current Law – 90% match

FY 16 – Traditional Match

Tobacco Funds 156.4 156.4

Hospital Assessment

245.9 0.0

General Fund 114.3 746.8

Federal Funds 2,630.6 2,244.1

Total Funds 3,147.3 3,147.3


FY 15 & FY 16 Executive Budget• How big is the problem?

o FY 15 - $160 m o FY 16 - $533.7 m

• AHCCCS Recommendationo 3% Provider Rate Reduction – in FY 15 o DD Provider rates exempto Flexibility for AHCCCS in analysiso DSH Changes o Some funding included for ALTCS Dental


Spending by Provider Type


20%

16%

15%15%

14%

9%

6%

3% 2%

PhysicianHospital IPHospital OPBehavioral HealthHCBSPharmacyNursing FacilitiesTransportationDental

AHCCCS Budget Rec • Governor’s Initiative for Administrative Simplification with

BHS and AHCCCS fully effective July 1, 2016• Current Structure is redundant – AHCCCS oversees BHS• No services are cut and no change in how services are

delivered• All existing contracts (and new awards) remain in place –

moves existing RBHA contracts to AHCCCS for oversight• This transition will be seamless to those who need

services and the family members that support them• We will be thoughtful in transition and work to bring the

best of both organizations together• We will be reaching out to stakeholders for input as part

of transparent process11Reaching across Arizona to provide comprehensive

quality health care for those in need

Total AHCCCS System Health Plan Profits

2007 2008 2009 2010 2011 2012 2013 2014 8 yr avg0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%


ED Utilization: % of Total Paid Amount


Level I Level II Level III Level IV Level V0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

1.7%

6.5%

29.2%

39.7%

22.9%

1.4%

6.6%

27.5%

39.4%

25.1%

SFY 2012SFY 2013

% Total Paid Amount

% o

f Tot

al P

aid

Am

ount

Hospital Uncompensated Care and Net Operating Profits, 2011-2013 ($ in millions)


Uncompensated Care Net Operating Profit$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

$1,000

201120122013

15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

-4

-2

0

2

4

6

8

10

12

Growth in National Health Expenditures and Gross Domestic Product (GDP), 1985-2013

SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, U.S Department of Commerce, Bureau of Economic Analysis and National Bureau of Economic Research, Inc.

An

nu

al P

erce

nt

chan

ge

July 1990- March 1991 Recession

March 2001- November 2001

Recession

Calendar Years

December 2007-June

2009Recession

Payment Modernization Success• Incremental movement in the system to

alternative payment structures • Alignment across the AHCCCS measures• Implementation of New APR-DRG structure • Work being done by plans to address low E-

prescribe rankings• Ready for 4-1-15 FQHC PPS Implementation• Developing Strong Learning Culture• SIM Design Funding


Payment Modernization Expectations• Accelerate Incremental growth in new

payment structure – • Continue to move discussion to Value

– Dr. Porter – Focus networks and contract incentives on high value providers

• Move APR-DRGs and other payments to better reflect Value

• 50% of our spend in Value by 201817Reaching across Arizona to provide comprehensive


IntegrationPopulation BH Funding Acute Funding Status

18,000 Members with SMI

$405 m $112 M Implemented April 1, 2014

17,000 CRS $25 m $126 m CRS - $59 m Acute

Implemented 10-1-2013

17,000 Members with SMI – Greater AZ

$419 m $117 m Planned 10-1-2015

60,000 Duals – 45% Ongoing

80,000 Acute Duals $25 m $144 Medicaid - $--- Medicare

Planned 10-1-2015


Integration Expectations• Successful 10-1-2015 Transitions• SB 1375 Report due to legislature

looking at delivery system for CMDP• DD Acute Contracts for 10-1-16 – look

at integration of BH – DSNP Requirements

• Continue to pursue Seamless Conversion

• Support Sustainability efforts for DSNP


Members with High Needs High Costs• System moved to meet 1-1-15 Requirement

for 20 members in active care coordination• Individual success stories – data sharingExpectations• Pursue Care Coordination/Management

regardless of open episode of care• Collaborative Effort – State – Plans - RBHAs• Additional requirements that work to scale

up efforts


Blind Spot Data• Successfully started sharing data• AHCCCS Successfully collecting more

dataExpectations• Want to see broader leverage of data

sourceso BH Data – Physical Health Datao Medicare Datao I.H.S & 638 Data

21Reaching across Arizona to provide comprehensive


Expectations• Consumer Engagement - 10-1-16 Waiver • Increased Copays – Oct 1. 2015 (?)• Supplemental Rebates – AHCCCS selectively will

be pursuing exclusive agreements – Start with Hep C

• Autism Services Focus• Efforts on Prescription Drug Abuse• Continued collaboration on AIHP efforts • Continued focus on Justice System transitions• Transparency – MCO Report Card – Provider

financials• Data Security• Ongoing support for HIT


AHCCCS Procurements• 10-1-15 Greater AZ RBHA Transition• 10-1-16 DD Acute Contracts • 10-1-17 ALTCS Contracts• 10-1-18 Acute Care • 10-1- ? RBHA


ahcccs update. ahcccs care delivery system 2 reaching across arizona to provide comprehensive...

Documents