AHCCCS Update: Comprehensive Healthcare Initiatives in Arizona
AHCCCS, the Arizona Health Care Cost Containment System, is dedicated to providing quality healthcare services to those in need across Arizona. This includes budget proposals, coverage expansions, healthcare expenditure details, and health indicators like uninsured rates and capitation growth. The program focuses on addressing healthcare challenges and improving access to essential services for the community.
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Reaching across Arizona to provide comprehensive quality health care for those in need 2
FY 17 Budget Prop 123 KidsCare July 26th ALTCS Dental Podiatry HB 2442 Reaching across Arizona to provide comprehensive quality health care for those in need 3
Employment and Recessions Reaching across Arizona to provide comprehensive quality health care for those in need 4
18-64 Uninsured Nationally Reaching across Arizona to provide comprehensive quality health care for those in need 5
Insurance coverage by Economic Status Reaching across Arizona to provide comprehensive quality health care for those in need 6
Expenditures for Restoration and Expansion $4,500.0 $3,969.8 $4,000.0 $3,755.0 $3,500.0 $3,124.3 $3,000.0 Federal $2,500.0 $3,437.0 Other State Match $3,239.6 $2,000.0 Hospital Assessment $2,586.4 Total Funds $1,500.0 $1,000.0 $500.0 $277.0 $268.5 $267.3 $264.3 $260.9 $248.1 $0.0 2015 Actual 2016 Estimate 2017 Estimate Reaching across Arizona to provide comprehensive quality health care for those in need 7
Average Annual Capitation Growth (%) 4.0 3.5 3.0 2.8 2.5 2.0 1.8 2.0 1.4 1.5 1.0 0.5 0.0 CYE'13 CYE'14 CYE 15 CYE 16 Reaching across Arizona to provide comprehensive quality health care for those in need 8
Eligibility and Payment Error Rate 10.00% 9.00% 8.00% 7.00% 6.00% AHCCCS Error Rate: 5.00% National Error Rate: 4.00% 3.00% 2.00% 1.00% 0.00% 2014 2011 Reaching across Arizona to provide comprehensive quality health care for those in need 9
Infant Mortality 12 10 8 Arizona 6 US 4 2 0 1992 2015 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Reaching across Arizona to provide comprehensive quality health care for those in need 10
CMDP 19,000 17,000 15,000 13,000 11,000 9,000 7,000 5,000 Reaching across Arizona to provide comprehensive quality health care for those in need 11
Children in Foster Care PMPM 1400 1200 1000 800 PH 600 BH 400 200 0 CMDP Non CMDP Reaching across Arizona to provide comprehensive quality health care for those in need 12
Integration Efforts to Date 1. Ongoing Duals >40% alignment DSNP 2. 2013 17,000 Kids with special needs 3. 2014 20,000 Individuals with SMI Maricopa 4. 2015 19,000 Individuals with SMI Greater AZ 5. 2015 80,000 dual eligible members Integrate BH 6. 2016 Administrative Merger 7. Future Possibilities 2017 29,000 members with DD BH & PH 2018 34,000 Children with Autism or at risk 2018 or future date Non-SMI adults BH 1. 2. 3. Reaching across Arizona to provide comprehensive quality health care for those in need 13
Health and Social Care Spending as a Percentage of GDP Health care Social care 40 30 20 10 0 FR SWE SWIZ GER NETH US NOR UK NZ CAN AUS Source: E. H. Bradley and L. A. Taylor, The American Health Care Paradox: Why Spending More Is Getting Us Less, Public Affairs, 2013. Reaching across Arizona to provide comprehensive quality health care for those in need 14
Social/Economic Determinant Efforts State Housing Funding for Individuals with SMI Multiple Plans have partnered to create and support community social service centers MCO pilot to invest in low- income housing subsidy AHCCCS has dedicated staff resources focused on housing employment peer services State only investments made through RBHAs 25 20 15 10 5 0 FY FY FY FY FY FY 2011 2012 2013 2014 2015 2015 Reaching across Arizona to provide comprehensive quality health care for those in need 15
The Network Growth All Participants 120 117 Number of Participants 100 80 78 60 40 33 23 33 11 20 - 2011 YE 2012 YE 2013 YE 2014 YE 2015 YE 2016 YTD 16
AHCCCS VBP Fee Schedule Changes 2014 Hospital IP APR-DRG 2015 - MCOs pay FQHC full rate 2016 - Hospitals bump for sharing data with HIE and meeting MU2 2016 - SNFs increase for those above avg with pneumococcal vaccine 2016 - Integrated Clinics- physical health 2016 stand alone ED new provider type 2016 Treat and Refer Reaching across Arizona to provide comprehensive quality health care for those in need 17
CMS Regulations Tsunami Access Requirements New Outpatient Drug Proposed MCO requirements Parity Requirements Home and Community Based Requirements DOL Overtime Requirements Capitation Rate Reviews Reaching across Arizona to provide comprehensive quality health care for those in need 18
Total Medicaid Managed Care Spending Expenditure in Billions Percentage 120 40 35 100 30 80 25 20 60 15 40 10 20 5 0 0 Reaching across Arizona to provide comprehensive quality health care for those in need 19
MCO Regs Finance Cap Rates MLR State Plan enrollment State Monitoring Enrollee Rights and Protections MCO Standards Quality Management Program Integrity Sanctions Reaching across Arizona to provide comprehensive quality health care for those in need 20
Dreamland by Sam Quinones 1980 - Porter and Jick 1 paragraph 1990 Scientific American called it an extensive study Paper for Institute for Clinical System Improvement a landmark report 2001 Time Magazine landmark study that addiction concerns basically unwarranted 1998 over 1,000 multi-disciplinary pain clinics 7 years later 85 Purdue marketed OxyContin as having less than 1% addiction Reaching across Arizona to provide comprehensive quality health care for those in need 21
Dreamland 1997 670 k Oxy scripts 2002 6.2 m US consumes 83% of world s oxycodone and 99% of world s hydrocodone (Vicodin and Lortab) Overdose deaths rose from 10 per day in 1999 to 48 in 2012 Book describes how Heroin distribution evolved and changed during this same time Actions 1. Read book 2. OIG CONG Strategies 3. Evaluate opportunities in plan meetings Reaching across Arizona to provide comprehensive quality health care for those in need 22
Interim Outcomes Long-Term Outcome Resources Activities Impact Adoption Acceleration Work Groups Time (18 months) Alignment Targeted agreement on components Engagement Communications Infrastructure Individual reach- outs Large stakeholder meetings Affinity Group Webinars Newsletters Events/conferenc es Blogs, social media, crowdsourcing Collaboration Portal Media Better Care, Smarter Spending, and Healthier People 30% APMs by 2016 GC Member Networks & other organizations ( multiplier effect ) Reach APM lessons broadly communicated 50% APMs by 2018 CAMH Staff Action CMS Support/Staff APMs implemented
Sprints Launched Patient Attribution Financial Benchmarking Performance Measurement Data Sharing Population Population- - Based Based Payment (PBP) Payment (PBP) Work Group Work Group Sprints Launched Elective Hip and Knee Replacement Maternity Cardiac Care Clinical Clinical Episode Episode Payment (CEP) Payment (CEP) Work Group Work Group
Proposed Funding (In Millions) Program DY 1 DY 2 DY 3 DY 4 DY 5 Totals American Indian CMC 35 35 35 35 35 175 Justice 20 20 20 20 20 100 BH/PH Int. Adults 137.5 137.5 137.5 137.5 137.5 687.5 BH/PH Int. Kids 137.5 137.5 137.5 137.5 137.5 687.5 Totals 335 335 335 335 335 1,675 Reaching across Arizona to provide comprehensive quality health care for those in need 26
DSRIP Timeline Reaching across Arizona to provide comprehensive quality health care for those in need 27
Reaching across Arizona to provide comprehensive quality health care for those in need 28
Employee Engagement 10 9 8 7 6 5 4 3 2 1 0 2012 2014 2015 2016 Reaching across Arizona to provide comprehensive quality health care for those in need 29
Lean Management System Update 1. Executive Branch Fundamentals Map 2. Governors Scorecard 3. Breakthrough Measures 4. Counter Measures 5. Visual Management Boards 6. Division Process Improvement Projects 7. Division Lean Champions 8. Training and Communication Reaching across Arizona to provide comprehensive quality health care for those in need 30
Reaching across Arizona to provide comprehensive quality health care for those in need 31
Questions? Reaching across Arizona to provide comprehensive quality health care for those in need 32
