AHCCCS Update. AHCCCS Care Delivery System 2 Reaching across Arizona to provide comprehensive...
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Transcript of 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
4Reaching across Arizona to provide comprehensive quality health care for those in need
Renewal Activity
Reaching across Arizona to provide comprehensive quality health care for those in need
5
Restoration/Expansion Actual to 2013 Estimates
6Reaching across Arizona to provide comprehensive quality health care for those in need
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
7Reaching across Arizona to provide comprehensive quality health care for those in need
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
8Reaching across Arizona to provide comprehensive quality health care for those in need
FY 15 & FY 16 Executive Budget• How big is the problem?
o FY 15 - $160 m o FY 16 - $533.7 m
• AHCCCS Recommendationo 3% Provider Rate Reduction – in FY 15 o DD Provider rates exempto Flexibility for AHCCCS in analysiso DSH Changes o Some funding included for ALTCS Dental
9Reaching across Arizona to provide comprehensive quality health care for those in need
Spending by Provider Type
10Reaching across Arizona to provide comprehensive quality health care for those in need
20%
16%
15%15%
14%
9%
6%
3% 2%
PhysicianHospital IPHospital OPBehavioral HealthHCBSPharmacyNursing FacilitiesTransportationDental
AHCCCS Budget Rec • Governor’s Initiative for Administrative Simplification with
BHS and AHCCCS fully effective July 1, 2016• Current Structure is redundant – AHCCCS oversees BHS• No services are cut and no change in how services are
delivered• All existing contracts (and new awards) remain in place –
moves existing RBHA contracts to AHCCCS for oversight• This transition will be seamless to those who need
services and the family members that support them• We will be thoughtful in transition and work to bring the
best of both organizations together• We will be reaching out to stakeholders for input as part
of transparent process11Reaching across Arizona to provide comprehensive
quality health care for those in need
Total AHCCCS System Health Plan Profits
2007 2008 2009 2010 2011 2012 2013 2014 8 yr avg0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
12Reaching across Arizona to provide comprehensive quality health care for those in need
ED Utilization: % of Total Paid Amount
13Reaching across Arizona to provide comprehensive quality health care for those in need
Level I Level II Level III Level IV Level V0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
1.7%
6.5%
29.2%
39.7%
22.9%
1.4%
6.6%
27.5%
39.4%
25.1%
SFY 2012SFY 2013
% Total Paid Amount
% o
f Tot
al P
aid
Am
ount
Hospital Uncompensated Care and Net Operating Profits, 2011-2013 ($ in millions)
14Reaching across Arizona to provide comprehensive quality health care for those in need
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
16Reaching across Arizona to provide comprehensive quality health care for those in need
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
quality health care for those in need
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
18Reaching across Arizona to provide comprehensive quality health care for those in need
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
19Reaching across Arizona to provide comprehensive quality health care for those in need
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
20Reaching across Arizona to provide comprehensive quality health care for those in need
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
quality health care for those in need
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
22Reaching across Arizona to provide comprehensive quality health care for those in need
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
23Reaching across Arizona to provide comprehensive quality health care for those in need