AHCCCS Complete Care and Targeted Investments Program Arizona

AHCCCS Complete Care and Targeted Investments Program Arizona Public Health Association Fall Conference October 3, 2018

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 driving towards an integrated healthcare system Reaching across Arizona to provide comprehensive quality health care for those in need Maintain core organizational capacity, infrastructure and workforce. 2

Vision - Integration at all 3 Levels Reaching across Arizona to provide comprehensive quality health care for those in need 3

AHCCCS Complete Care Health Plans (ACC Plan) Furthering Integrated Healthcare in a single Health Plan that will: • Include physical and behavioral healthcare service providers (including CRS); • Manage the provider network for all of your healthcare services. • Provide comprehensive managed care for the whole person.

Integration Progress To Date 1989 2013 2014 2015 2016 2018 95% 40% SMI Greater AZ 17, 000 SMI Maricopa 18, 000 20% 0 AIHP/TRBHA 80, 000 GMH/SA Duals 80, 000 GMH/SA Adults & Non CMDP Children Approximately 1. 5 million CRS 17, 000 ALTCS /EPD 29, 200 Reaching across Arizona to provide comprehensive quality health care for those in need 5

Current Care Delivery System Pre 10/1 6

Who Is Affected October 1, 2018? • Affects most adults and children on AHCCCS • Members enrolled in Children’s Rehabilitative Services (CRS) It does not affect: • Members on ALTCS (EPD and DES/DD); • Adult members with a serious mental illness (SMI); and • Most foster children enrolled in CMDP 7

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ACC Plan Geographic Service Areas 10

AHCCCS Complete Care Plans Central GSA South GSA Banner University Family Care North GSA Care 1 st Steward Health Choice Arizona Complete Health - CCP Magellan Complete Care Mercy Care United. Healthcare Community Plan (Pima County Only) 11

Care Delivery System as of Oct. 1, 2018 12

Members Changing Health Plans Geographic Service Area Estimated Members Central 10, 400 South 199, 575 North 83, 445 Total 293, 420 Chart reflects change of Physical Health Plan only – not RBHA Pima county estimate – 105, 200 13

Member Assignment and Choice • Members stay in current plans becoming ACC Plans o Choice of other ACC Plans on their annual enrollment choice date. • Members in exiting plans were assigned an ACC Plan and given choice of other ACC Plans • Less than 3% of members chose a different plan than assigned • American Indian members have ongoing choice of AIHP, AIHP/TRBHA or ACC Plan 14

Special Choice for Members getting services through a RBHA • Certain members previously receiving services with a RBHA had a choice for 10/1/18 to elect to stay with the “RBHA-affiliated” ACC Contractor o Members given this choice must: § not already be enrolled in a RBHA-affiliated Plan that will be an ACC Plan; or § not already be getting choice of all ACC Plans (including RBHAaffiliated ACC Plan) due to current enrollment in exiting plan 15

The Benefits of Integration • • • One Plan One Payer One Provider Network Easier to Navigate Streamline care coordination to get better outcomes • Improve a person’s whole health

Other things to be aware of… 17

Changes with RBHA services Regional Behavioral Health Authorities (RBHAs) will no longer serve most adults and children as of October 1, 2018 (with exceptions below). RBHAs will continue to provide and serve: • Foster children enrolled in CMDP • Members enrolled with DES/DD; • Individuals determined to have a serious mental illness (SMI) • Crisis services, grant funded, and state-only funded services 18

RBHA Affiliated ACC Plans GSA RBHA (current) RBHA Affiliated ACC North Health Choice Integrated Care (HCIC) Steward Health Choice Arizona Central Mercy Maricopa Integrated Care (MMIC) Mercy Care South Cenpatico Integrated Care (CIC) Arizona Complete Health – Complete Care Plan 19

RBHA/TRBHA and Crisis Services • The Crisis system responsibilities will remain with the RBHA (in their respective GSA areas) 20

Medicare Advantage D-SNP Plan Requirement • To further integration, each ACC Plan is required to have a Medicare Advantage DSNP option to offer alignment to members with Medicare. • Members with health plan changes may need to make future changes to Medicare enrollment to continue to be aligned. 21

Transition Efforts • Videos on AHCCCS and Plan websites • Web Page/FAQs • Statewide Public Meetings • Stakeholder Organization meetings • ACC Plan Meetings and Readiness Assessment o Staffing o Data/Systems – IT Demo o Care Transition o Network Reaching across Arizona to provide comprehensive quality health care for those in need 22

ACC Web Pages www. azahcccs. gov/ACC • GSA map with plans • Community meetings • Videos in English, Spanish, and audio in Navajo • FAQs • CRS • American Indians • Providers 71, 000 unique hits in 2018 23

ACC Member Videos 3 member videos (general, CRS, American Indian) English, Spanish and audio in Navajo “We LOVED the ACC video uploaded onto the AHCCCS website yesterday. . . ” Phoenix CRS General video: 8, 465 views “Thank you for everything you are doing for our patients to inform them and prepare them for the changes 10/1/18. We are excited to share the ACC videos in the waiting rooms and patient rooms. . ” CRS video: 789 views American Indian video: 694 views Phoenix CRS 24

ACC Community Forums 70+ presentations 2000+ attendees ACC Presentation video: 696 views “…Your time and knowledge greatly helped put this parents fears at a little more ease. ” Flagstaff Parent Denise M. “We appreciate you coming all the way to Sierra Vista to share this information with us. ” NAMI Southeastern AZ “Thank you for coming to our communities today and for providing us with valuable information that we can use when we speak with the new ACC plans coming into our area. ” Yuma CRS Practice Manager “Thank you so much! The information you provided today was exactly what we needed to explain things to our members and our community. ” Regional Center for Border Health 25

ACC Social Media 26

ACC Transition Communication 1. Success depends on shared commitment that those that we serve remain at the center of all decision making 2. We have done a lot of planning but challenges will invariably surface – may need to resolve some issues after the fact 3. Number of member protections in place during transition 27

Member Protections • Provider Flyers/Director’s Message • AZ Association of Health Plan Letter to Providers • • Don’t turn transitioning members away Allow sufficient time to establish a contract or transition the member • AHCCCS contractually required ACC Plans to pay non-contracted providers 28

Member Protections • ACC Plan to allow: o o o PCP transition – 90 days Ongoing care from a specialists – 6 months Behavioral health services – 6 months Members with CRS conditions to continue access to Multispecialty Interdisciplinary Clinics Pregnant women in the third trimester Honor previously approved authorizations - 30 days 29

We have talked about the plan level… let’s talk provider Reaching across Arizona to provide comprehensive quality health care for those in need 30

Value Based Purchasing • Value-Based Purchasing (VBP) is a cornerstone of AHCCCS’ strategy to bend the upward trajectory of health care costs. • WHY: To leverage the managed care model toward value-based health care systems where members’ experience and population health are improved o To align incentives between managed care organizations and providers o There is a commitment to continuous quality improvement and learning. o • Examples: o o o Centers of Excellence Differential Adjusted Payment Alternative Payment Models E Prescribing Targeted Investments 31

Integration ACC and the Targeted Investments Program • Many TI requirements support and are complementary to the transition to ACC. • Like ACC, TI is intended to connect physical and behavioral health services to treat the members’ whole person health care needs • TI supports greater coordination among providers within the same network to provide better health outcomes for members. 32

Targeted Investments Program • $300 million authorized by CMS in January, 2017 as a part of the 1115 waiver • A five year project providing resources to participating providers to support the integration of behavioral and physical health care. • TI year 2: October 1, 2017 -September 30, 2018 33

Participation • Providers eligible to participate include: Adult and pediatric primary care practices o Adult and pediatric behavioral health organizations o Acute and psychiatric hospitals o Justice Co-located clinics o • Almost 600 sites participating across the state. 34

View of the TI Program from 10, 000 Feet • ACC Alignment • Identify & focus: persons at high risk • Care management systems, processes, & infrastructure • Communication, Coordination, Integration • Data sharing Reaching across Arizona to provide comprehensive quality health care for those in need 35

Core Components and Milestones TI providers commit to implementing processes and systems that enable physical and behavioral health providers to better coordinate care for AHCCCS members. Examples of these requirements include: Screening for mental health conditions and social determinants of health • Utilizing an integrated care plan for members receiving both physical and behavioral health care • Utilizing a care manager in primary care practices • Actively participating in the state health information exchange [Health Current]. • 36

TI Goal: Demonstrate progress on the integration continuum • Measured with the Integrated Practice Assessment Tool • Average Level: 2. 2 • Next Assessment: September 2019 37

Examples of TI-ACC Interface • High risk registry: TI participants use of MCO data • Practice care manager: coordinate with the MCO care coordinators • Integrated care plan: alignment with MCOs • SDOH screens: alignment with MCOs’ instruments • Communication protocols with physical health, behavioral health, and health plans • Use of/coordination with MCO community based resources 38

ACC-Targeted Investments • High risk registry [Primary Care]- track members at increased risk of near term BH utilization and decline physical and/or BH status [for children - chronic physical, developmental, behavioral or emotional conditions, plus children at risk for ASD] • Practice care manager [Primary Care]- for members included in the high-risk registry [support transitions of care, coordinate medical/BH care, social service support] • Screen for SDOH: develop procedures for intervention or referral based on the results of the screen 39

ACC-Targeted Investments • Collaborative communication protocols- between physical health and behavioral health providers for referrals, communicating relevant clinical data, coordinating with MCO care managers • Use of community-based resources- Establishment of relationships with social service agencies • Trauma-Informed Care protocols- Primary Care: How assessments or referrals for assessments will be made Behavioral Health: How screening is conducted [frequency/ which screening tools] 40

Health Information Integration-HIE 41

Key TI/ ACC Opportunities: Data • Health Current-Health Information Exchange Admission/Discharge/Transfers [ADT] o Bi-directional: Data set/Timeline o Available Data Examples • o o o Medications Diagnosis/Problem List Procedures/Treatments Diagnostic Test Results Immunizations 42

Thank You. 43