AHCCCS Dual Integration AHCCCS Managed Care Organization Update Meeting

1. AHCCCS Dual IntegrationAHCCCS Managed Care Organization Update Meeting May 16, 2012 Our first care is your health care Arizona Health Care Cost Containment System

2. AHCCCS Dual Enrollment as of January 2012 Our first care is your health care Arizona Health Care Cost Containment System 2

3. AHCCCS DUAL ELIGIBLE MEMBERS MEDICARE ENROLLMENTJanuary 2012 Our first care is your health care Arizona Health Care Cost Containment System

4. Dual Eligible Member Complexity and Fragmentation • Problems with Fragmentation • Navigating multiple systems adds confusion for members • Lack of real-time clinical data frustrates those trying to help manage member – results in higher costs and poorer outcomes • Diffused accountability = No accountability • Fragmentation incentivizes cost shifting – not care coordination Our first care is your health care Arizona Health Care Cost Containment System

5. AHCCCS Demonstration Proposal • 3 Year Demonstration • January 1, 2014 Statewide Implementation • 3 way contract – CMS – State – Plan • 3 Populations • ALTCS E/PD: 21,000 • Acute members with Serious Mental Illness in Maricopa County: 7,000 • Acute: 77,000 • Still many questions – requires flexibility Our first care is your health care Arizona Health Care Cost Containment System

6. AHCCCS Demonstration Proposal • Plan Selection • ALTCS E/PD: Use existing ALTCS Contractors • Members with Serious Mental Illness in Maricopa County: Maricopa RBHA required to be Demo plan or D-SNP • Acute: Plan selection through upcoming RFP issued Fall 2012 • All plans will be required to meet additional CMS requirements including: • Demonstration specific application • Part D formulary approval • Model of Care approval Our first care is your health care Arizona Health Care Cost Containment System

7. AHCCCS Demonstration ProposalVision and Rationale • Passive (automatic) enrollment into integrated plan with opt-out choice to Original Medicare • Build on the current AHCCCS managed care structure • Improve current D-SNP model • Ongoing automatic enrollment • Align administrative processes Our first care is your health care Arizona Health Care Cost Containment System

8. AHCCCS Demonstration ProposalVision and Rationale • Members would have one point of contact for all services – Prescription drugs, all Medicare and Medicaid benefits • Providers would have one point of contact for prior authorizations and billing • Would allow plans to better coordinate care by having access to all member information • Integrates Admin processes – Appeals, marketing, quality measures, reporting, oversight Our first care is your health care Arizona Health Care Cost Containment System

9. AHCCCS Demonstration ProposalExpected Outcomes • Improved outcomes, including improved health status of dual eligibles enrolled in the Demonstration • More efficient and effective utilization of services • A reduction in cost-shifting between Medicare and Medicaid plans • Improved access to information and data • Consolidation of accountability for care • A reduction in duplication of services • An increase in enrollee satisfaction, leading to an increase in compliance • Administrative efficiencies Our first care is your health care Arizona Health Care Cost Containment System

10. AHCCCS Demonstration ProposalUpcoming Dates • April 2012: Draft proposal published for comment – Comments due TOMORROW by 5:00pm! • May 30, 2012: Submit final proposal to CMS • June 2012: CMS makes proposal available for additional 30 day comment period • June 8: Public Meeting to discuss final proposal submission • Summer/Fall 2012: State begins negotiation with CMS to integrate Medicare and AHCCCS requirements and finalize Demonstration • Spring 2013: 3-way contracts signed with CMS, State, and Plans • Ongoing stakeholder engagement Our first care is your health care Arizona Health Care Cost Containment System