AHCCCS Targeted Investments Program Overview
AHCCCS Targeted Investments Program, funded through the 1115 Waiver renewal, offers $285M in financial incentives to AHCCCS providers for integrated care. The program focuses on reducing fragmentation between acute and behavioral health care, improving integration at the provider level, and enhancing health outcomes for members with physical and behavioral health needs across Arizona.
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Presentation Transcript
Targeted Investments Program AHCCCS Update May 17, 2017
Targeted Investments Program Overview Funded through the 1115 Waiver renewal $285M in financial incentives available to participating AHCCCS providers to develop processes for integrated care, including: o Increasing integration of physical and behavioral health (BH) care o Increasing care coordination for individuals with BH health needs Reaching across Arizona to provide comprehensive quality health care for those in need 2
TI Focus & Goals TI Program Focus Population? o AHCCCS members with behavioral health conditions Goal of the TI Program? Reduce fragmentation between acute and BH care o Improve integration at the provider level for members with BH needs Improve health outcomes for members with physical health and BH needs Reaching across Arizona to provide comprehensive quality health care for those in need 3
Which AHCCCS providers are eligible to participate? Eligible providers selected via the application process; must have contracts with AHCCCS MCOs Eligible provider types include: o Primary care o Outpatient mental health (Provider Type 77) o Hospitals/Psychiatric Hospitals o Integrated Clinics Eligible providers can be an individual provider or a group of providers that practice across one or more practice sites Reaching across Arizona to provide comprehensive quality health care for those in need 4
TI Focus Areas Adults with behavioral health needs Adults transitioning from the justice system Children with behavioral health needs, including care for children with ASD and care for children in the child welfare system Reaching across Arizona to provide comprehensive quality health care for those in need 5
Projects Ambulatory Care: Integrated care at the ambulatory care site for adults and children with behavioral health needs Hospital: Care coordination during and after hospital stay for behavioral health dx Justice: Integrated care delivered in settings co-located at select county probation & DOC parole offices Reaching across Arizona to provide comprehensive quality health care for those in need 6
Areas of Concentration-Ambulatory Project Adults with Behavioral Health Needs Primary Care Provider Adults with Behavioral Health Needs Behavioral Health Provider Children/Youth with Behavioral Health Needs Pediatric Primary Care Provider Children/Youth w/ Behavioral Health Needs Pediatric Behavioral Health Provider Reaching across Arizona to provide comprehensive quality health care for those in need 7
How will a provider receive incentive payments? Year 1 Incentive payments will be made to successful applicants Years 2-5 Incentive payments due to each TI participant will be calculated by AHCCCS performance metrics: o Years 2 & 3: AHCCCS will evaluate participating provider performance based on documentation of the completion of milestones associated with relevant Core Components. o Years 4 & 5: AHCCCS will evaluate participating provider performance based on achievement of clinical performance measures Reaching across Arizona to provide comprehensive quality health care for those in need 8
How are TI Incentive Payments Structured Under 438.6(c)? Using TI participants performance on required metrics, AHCCCS will annually calculate incentive payments due, segmented by MCO attribution AHCCCS will provide MCOs with participating provider list and specific TI payments earned AHCCCS will make a lump sum payment to the MCOs equal to the incentive payments due TI providers o Payments must be dispersed to providers within 30 business days Reaching across Arizona to provide comprehensive quality health care for those in need 9
MCO Responsibilities Annual TI payments to providers will be made by the MCOs Year 1, MCOs will generate the TI payments after receiving the adjusted capitation rates and TI participant payment data from AHCCCS ~ October 2017 Years 2-5, TI participant payment information will require additional time for AHCCCS to calculate (to the extent encounter data is used lag will be needed) Reaching across Arizona to provide comprehensive quality health care for those in need 10
MCO Responsibilities cont. Utilizing payment report provided by AHCCCS, respond to provider TI payment questions o Refer to AHCCCS as needed resource matrix provided Execute CYE 2017 and CYE 2018 MCO contract amendments that describe AHCCCS and MCO responsibilities for making payments to TI Program participants Follow the Targeted Investments Policy [AMPM Chapter 200- in development] Reaching across Arizona to provide comprehensive quality health care for those in need 11
MCO Administrative Funding $10,000 per MCO per year o RBHAs to be paid more for Year 1 Premium tax will be added HIF incurred costs paid in future Reaching across Arizona to provide comprehensive quality health care for those in need 12
Questions? Reaching across Arizona to provide comprehensive quality health care for those in need 13
Thank You. Reaching across Arizona to provide comprehensive quality health care for those in need 14
