AHCCCS Care Delivery System. Reaching across Arizona to provide comprehensive quality health care for those in need
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1 AHCCCS Care Delivery System 1
2 GAO Medicaid Spending Report Duals excluded (No Expansion) 1% of Population = 25% of spend 5% = 50% of spend 25%= 75% of spend Bottom 50% = 8% of spend 2
3 GAO - Conditions of Members (%) Condition Asthma Diabetes HIV/AIDS MH SUD Delivery LTC None Asthma Diabetes HIV/AIDS MH SUD Delivery LTC
4 Economic Impact of Integration (Milliman) Costs for chronic medical conditions for those with co-occurring MH/SA are 2 to 3X Diabetes PMPM o w/o MH/SA - $1,068 w/ $2,368 Total Opportunities o Medicaid $100 B (Pre-Expansion) o Medicare $30 B o Commercial $162 B o Total Achievable $26-48 B 4
5 AHCCCS Strategic Plan Reaching Across Arizona to Provide Comprehensive, Quality Health Care for Those in Need Bend the cost curve while improving the member s health outcomes Pursue continuous quality improvement Reduce fragmentation in healthcare delivery driving towards an integrated system Maintain core organizational capacity, infrastructure and workforce. 5
6 Administrative Simplification 6
7 Delivery System Transformation 1. Long Term Care Services and Supports 2. Dual Eligible Members 3. Members with Serious Mental Illness 4. Children with Special Needs 5. GMH/SUD Carve Outs HN/HC members 6. American Indian Health Program 7. Foster Care Children 8. Justice System Transitions 9. HIT Leverage 7
8 Percentage % Effective Use of Home and Community Based Care Nursing Facility ALTCS Trend in HCBS Utilization Home and Community 8
9 AHCCCS Dual Eligible Members Medicare Enrollment October 2014 MA Plan 16% Aligned Same AHCCCS & DSNP 45% Medicare FFS 39% Medicare FFS Aligned Same AHCCCS & DSNP MA Plan 9
10 Integration Population BH Funding Acute Funding Status 18,000 Members with SMI $405 m $112 M Medicaid + Medicare for 50% Implemented April 1, ,000 CRS $25 m $126 m CRS - $59 m Acute 17,000 Members with SMI Greater AZ $419 m $117 M Medicaid + Medicare for 40% 80,000 Acute Duals $25 m $144 Medicaid + Medicare 28,000 Members with Developmental Disabilities $34 m $124 m Medicaid + Medicare for 20% Implemented Planned Planned RFI on Street for procurement 10
11 Maricopa Integration for Members with Serious Mental Illness Medicaid Behavioral Health Housing & Employment Medicare D-SNP Single MCO Medicaid Physical Health Case Mgmt. Care Mgmt. 11
12 MMIC First Year Results Integrated Health Homes o o 13% Whole Health SMI Clinic % PCMH 68.6% Virtual Health Home MMIC has implemented a 16 question health risk assessment Began Value Based Purchasing with ACT Teams including ED- Readmissions Housing Employment Created Medical Assertive Community Treatment Team Created Forensic ACT Team to partner with Justice System Permanent supportive housing from 2,724 (7-14) to 3,686 (3-15) Supported Employment 473 (7-14) to 670 (3-15) Peer and Family Support Utilization 2,323 (7-14) to 3,854 (3-15) 12
13 GMH/SUD Adults Care Coordination Contract requires focused engagement on HN/HC members 686 members engaged Data 46 members graph One plan partnered Circle the City - homeless Transitioned 28 to housing Utilization over 160 IP & ED below 20 Take to scale IP Util Obs Util ED Util Q Q
14 Justice System Transition 120,000 move through annually 9,000 AHCCCS members in system at some point in month DOC/Counties spend $250 m % MH/SA AHCCCS Suspends and Reinstates Covers IP stays Developing care coordination efforts Developing enrollment efforts 14
15 American Indian Health Program: Care Coordination Initiative Staff Relationships Data The Model 15
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