Acute RFP Public Input Meeting

1. Acute RFP Public Input Meeting 1 January 18, 2012

2. Welcome Monica Coury Assistant Director Office of Intergovernmental Relations 2 January 18, 2012

3. AHCCCS 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. 3

4. AHCCCS Federal • AHCCCS Administration • State Health Plans • • Program Contractors for Long Term Care • County • State Agencies • Medical Policy • DHS • Eligibility (Special Populations) · · Behavioral Health Eligibility/DDD/CMDP • Private • DES • Contract for Medical and Long Term Care Services • Monitor Quality of Care and Financial Viability • Information Services • Fee-For-Service • Budget and Claims Processing • Native Americans • Emergency Services • Legal • Member Cost Sharing • Intergovernmental Relations Arizona Health Care Cost Containment System Funding - Medical Care - Long Term Care - Healthcare Group 4

5. 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 5

6. AHCCCS Who Does AHCCCS Serve?* 6 * As Of – 12/1/2011

7. Total Population Percentages Child 0-17 48.7% Adult 18-21 6.3% Adult 22-64 39.2% Adult 65-79 4.0% Adult 80+ 1.7% AHCCCS POPULATION DEMOGRAPHICS – AS OF 12/1/2011 Ethnicity Percentages Asian /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% Gender Male – 44.6% Females – 55.4%

8. AHCCCS AHCCCS Population 8

9. AHCCCS 52,150 83,042 APACHE COCONINO (4) (4) 34,479 4, 855 17,181 MOHAVE (4) 50,646 45,724 NAVAJO (4) YAVAPAI 15,282 196,261 (6) 34,479 LA PAZ 668,376 (2) GILA 3,095 MARICOPA (8) (12) 9,352 GREENLEE (14) 1,340 668,376 33,846 PINAL GRAHAM YUMA (8) (14) (2) 41,294 7,250 49,055 PIMA COCHISE (10) (14) 181,329 25,256 SANTA CRUZ (10) 14,932 Geographic Service Areas Acute Enrollment As of 12/1/2011 Health Plan Enrollment GSA Number Acute APIPA, HCA 2 PHP, HCA 4 PHP, BWY 6 PHP, UFC 8 APIPA, HCA, UFC, MCP, PHP 10 APIPA, Care 1st, HCA, MHP, MCP, PHP 12 MCP, UFC 14 Total Health Plan Enrollment = 1,118,800 9

10. AHCCCS Current Acute Care Contractors & Membership as of 12/1/2011 10

11. 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) Contract Requirements 11

12. 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 Contract Requirements – con’t. 12

13. Program Integrity Verification of service requirements Cost avoidance reporting Fraud and abuse Contract Requirements – con’t. 13

14. 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) Contractor Oversight AHCCCS monitors Contractors’ performance to ensure Contractor is able to perform under the contract via: 14

15. 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 Over the next 24 months AHCCCS must work on implementing the following by October 1, 2013: AHCCCS Contracting 15

16. AHCCCS Performance Measures Measures Exceeding the National Mean 10/1/2009 – 9/30/2010 96.3% 96.3% 100.00% 88.4% 88.4% 80.00% 64.1% 60.2% 60.00% 40.00% 20.00% 0.00% Well Child Visits First 15 Oral Health Care Appropriate Medication Use Months of Life for Asthma AHCCCS Medicaid Rate HEDIS Medicaid Mean

17. AHCCCS Performance Measures Measures Exceeding the National Mean 10/1/2009 – 9/30/2010 100.0% 89.0% 88.8% 88.1% 88.3% 80.0% 76.4% 60.0% 48.1% 45.7% 52.9% 40.0% 20.0% 0.0% Adolescent Well Care Oral Health Care Children's Access To PCP - Children's Access To PCP - Visits 25 Mos - 6 Yrs 12 – 19 Yrs AHCCCS KidsCare Rate HEDIS Medicaid Mean

18. 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 Health Care Reform 18

19. Health Care Reform Estimates 19

20. AHCCCS RFP Milestone Dates 20

21. Web Address http://www.azahcccs.gov/commercial/Purchasing/RPFInfo/YH14-0001/YH14PublicMeeting.aspx E-mail Address AcuteRFP@azahcccs.gov Acute RFP Contact Information