AHCCCS

Acute RFP Public Input Meeting

January 18, 20121

AHCCCS

Welcome

Monica Coury

Assistant Director

Office of Intergovernmental Relations

2January 18, 2012

AHCCCS

January 18, 2012

Mission:

Reaching across Arizona to provide comprehensive, quality health care for those in need.

Vision:

Shaping tomorrow’s managed health care…from today’s experience, quality and innovation.

Customer:

AHCCCS recognizes many internal and external customers, but the fundamental focus that inspires our efforts:

Our primary customers are AHCCCS members.

Mission:

Reaching across Arizona to provide comprehensive, quality health care for those in need.

Vision:

Shaping tomorrow’s managed health care…from today’s experience, quality and innovation.

Customer:

AHCCCS recognizes many internal and external customers, but the fundamental focus that inspires our efforts:

Our primary customers are AHCCCS members.

AHCCCS

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AHCCCS

January 18, 2012

AHCCCS

AHCCCSAdministration

- Medical Care

- Long Term Care

- Healthcare Group

• Health Plans

•Program Contractors for Long Term Care

• State AgenciesDHS

· Behavioral Health DES

· Eligibility/DDD/CMDP

• Fee-For-Service

• Medical Policy

• Eligibility (Special Populations)

• Monitor Quality of Care and Financial Viability

• Information Services

• Budget and Claims Processing

• Legal

• Intergovernmental Relations

• Contract for Medical and Long Term Care Services

Funding

•Federal

• State

• County

• Private

Member Cost Sharing

Native AmericansEmergency Services

Arizona Health Care Cost Arizona Health Care Cost Containment SystemContainment System

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AHCCCS

January 18, 2012

Acute Care Program Highlights The AHCCCS Acute Care Program will celebrate its 30th anniversary on

10/1/12 The Acute Care Program provides coverage for a wide array of

services including, but not limited to: Hospital services (inpatient & outpatient) Professional Practitioner Services Pharmacy Lab & x-ray Transportation

AHCCCS seeks competitive bids every five years from interested health plans who wish to serve AHCCCS members

Acute Care members are offered a choice of health plans in every county in Arizona

Members have access to a robust network of health care providers

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AHCCCS

January 18, 2012

AHCCCS

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Who Does AHCCCS Serve?*

Program Enrolled Members

Member Profile

Acute Medicaid KidsCare

1,266,822

13,536

Primarily children and women with children. Children through the age of 18.

ALTCS (Long Term Care)

51,781 Individuals with developmental disabilities, physical disabilities, or over 65 years of age.

Other (QMB, SLMB, QI-I)

36,699

Total

1,368,844*

* As Of – 12/1/2011

AHCCCS

January 18, 2012

AHCCCS POPULATION DEMOGRAPHICS – AS OF 12/1/2011

Total Population PercentagesChild 0-17 48.7%Adult 18-21 6.3%Adult 22-64 39.2%Adult 65-79 4.0%Adult 80+ 1.7%

GenderMale – 44.6%Females – 55.4%

Ethnicity PercentagesAsian /Pacific Island 1.92%

Black 6.78%

Caucasian/White 34.74%

Cuban/Haitian 0.01%

Hispanic 39.95%

Native American 10.21%

Other 0.45%

Unknown 5.94%

AHCCCS

January 18, 2012

AHCCCS PopulationAHCCCS

8

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

FY 03 FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 FY 11

June 30 Enrollment

AHCCCS

January 18, 2012

Geographic Service AreasAHCCCS

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Total Health Plan Enrollment = 1,118,800

83,042

34,479

52,150

668,376

196,261

50,646

33,846

Health Plan EnrollmentGSA Number Acute

4

6

2

12

10

8

14

COCONINO

(4)17,181

NAVAJO(4)

15,282

APACHE(4)

4, 855

MOHAVE

(4)45,724

LA PAZ

(2)3,095

YUMA(2)

49,055

MARICOPA(12)

668,376

PINAL

(8)41,294

GRAHAM

(14) 7,250

GILA

(8) 9,352

PIMA

(10)181,329

COCHISE(14)

25,256

YAVAPAI

(6)34,479

SANTA

CRUZ

(10)

14,932

GREENLEE

(14)

1,340

Acute Enrollment As of 12/1/2011

APIPA, HCA

PHP, HCA

PHP, BWY

PHP, UFC

APIPA, HCA, UFC, MCP, PHP

APIPA, Care 1st, HCA, MHP, MCP,

PHP

MCP, UFC

AHCCCS

January 18, 2012

AHCCCS

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Contractor Membership

Arizona Physicians IPA, Inc. (APIPA)

248,004

Bridgeway Health Solutions 17,219

Care 1st 49,783

Health Choice AZ 185,354

Maricopa Health Plan 53,665

Mercy Care Plan 298,157

Phoenix Health Plan 194,515

University Family Care 72,103

Current Acute Care Contractors & Membership as of 12/1/2011

AHCCCS

January 18, 2012

Contract Requirements Program

Quality Management Clinical performance measures Performance improvement projects Ensure receipt of EPSDT and maternal child health services Quality of Care tracking, trending, intervening as

necessary

Medical Management Utilization data analysis and intervention Utilization management tools (PA, concurrent/retrospective

review, chronic illness management, case/care coordination)

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AHCCCS

January 18, 2012

Contract Requirements – con’t. Network

Network requirements including accessibility and consideration of geography and physician referral patterns

Monitoring for improvement and resolution of service gaps

Financial/Claims/Encounters Financial viability requirements to ensure the ability to

perform and serve AHCCCS members Claims payment timeliness and accuracy Electronic reporting of all claims paid via encounter

submissions

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AHCCCS

January 18, 2012

Contract Requirements – con’t.

Program IntegrityVerification of service requirementsCost avoidance reportingFraud and abuse

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AHCCCS

January 18, 2012

AHCCCS monitors Contractors’ performance to ensure Contractor is able to perform under the contract via:

Contractor Oversight

Operational and Financial Review (OFR) Deliverable review Clinical performance measures Quality improvement projects Medical Management/Utilization Management Provider network monitoring Claims payment timeliness and accuracy Grievance System (member grievances and

appeals and claim dispute monitoring)

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AHCCCS

January 18, 2012

Over the next 24 months AHCCCS must work on implementing the following by October 1, 2013:

AHCCCS Acute Care Contract – $35 billion plus - largest procurement in the history of State Government

AHCCCS CRS Contract - $500 million plus – New Integration and Alignment Structure

DHS – Maricopa Integrated RBHA - $5 billion plus

AHCCCS Contracting

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AHCCCS

January 18, 2012

AHCCCS Performance MeasuresMeasures Exceeding the National Mean 10/1/2009 – 9/30/2010

64.1%

96.3% 96.3%

60.2%

88.4% 88.4%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Well Child Visits First 15Months of Life

Oral Health Care Appropriate Medication Usefor Asthma

AHCCCS Medicaid Rate HEDIS Medicaid Mean

AHCCCS

January 18, 2012

AHCCCS Performance Measures

89.0% 88.8%

52.9%

76.4%

88.3% 88.1%

48.1% 45.7%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Adolescent Well Care

Visits

Oral Health Care

12 – 19 Yrs

Children's AccessTo PCP -

Children's AccessTo PCP -

25 Mos - 6 Yrs

AHCCCS KidsCare Rate HEDIS Medicaid Mean

Measures Exceeding the National Mean 10/1/2009 – 9/30/2010

AHCCCS

January 18, 2012

Health Care ReformAHCCCS

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Medicaid Expansion – up to 133% FPL New requirements regarding eligibility - MAGI Goal is to have streamlined processes

Health Care Exchange Medicaid systems must be interoperable with Exchange so

Exchange customers first are screened for Medicaid and then screened for Exchanged Subsidy (133% - 400% FPL)

How will Medicaid health plans work with Qualified Health Plans in the Exchange to manage coordination of care for individuals who move back and forth.

AHCCCS

January 18, 2012

Health Care Reform Estimates

Eligible Participants

Exchange 621,000 479,000

AHCCCS 431,000 247,000

SHOP Exchange

1,822,000 510,000

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AHCCCS

January 18, 2012

RFP Milestone DatesAHCCCS

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ACTIVITY DATE

Public Meeting January 18, 2012

RFP Issued November 2012

Proposals Due January 2013

Contracts Awarded March 2013

Readiness Reviews/Transition Activities Begin April 2013

New Contracts Effective October 1, 2013

AHCCCS

January 18, 2012

Acute RFP Contact Information Web Address

http://www.azahcccs.gov/commercial/Purchasing/RPFInfo/YH14-0001/YH14PublicMeeting.aspx

E-mail AddressAcuteRFP@azahcccs.gov