Value Based Contracts Cenpatico

Population Health Management Keep children and families healthy Keep them engaged Be proactive with services Keep them in their home and in school Agency becomes at risk for cost of care for children they serve Progressively higher percentage – Fully at risk on 1/1/18 Cost effective to provide services in house Have skills at utilization management

Basics Per member per month AzCA receives a monthly payment for all members open during that month Example – if we have 4000 children open. We get 300 per child – payment is 1.2 million dollars for that month

PMPM payment

Contract requirements Penetration rates Each child must receive a face to face service at least every 90 days. For DCS children – every 30 days The threshold is 80% Encounters Threshold is 85% Example – If we are contracted to provide 1M of encounters for that month we would need to bill at least $850,000

Penetration rate

Encountering rate (currently must meet encounter rate for all funding streams)

Additional metrics performance measures Inpatient utilization – percentage of inpatient days per number of children (< or = to 50) Access to care – intakes within required time frame Out of home readmission rates CMDP penetration rates (children in DCS must be seen every month ) CMDP access to care (72 hours) Multiple concurrent antipsychotics E-SCRIPTS

Charge Backs AzCA will pay Cenpatico money that was used by them to pay for specialty services provided by agencies other than AzCA Example – if nothing changes AzCA would pay back over 1M dollars for services provided by Easter Seals Blake foundation Currently we are paying 10% of the total billed That percentage will gradually go up We will be fully at risk on 1/1/18 Shared Savings pool AzCA can be eligible for financial incentives for meeting all requirements

Services that we don’t provide to our families

Outside Scope of Work

SWOT analysis Strengths Weaknesses Comprehensive services established Trauma services, HNCM, MMWIA Excellent infrastructure Data collection and analysis Weaknesses Infant and early childhood services Autism services Respite Staff is not accustomed to this model of care

Opportunities Threats Develop new programs (above) Improve utilization review (hiring staff) Threats Resistance to change of culture and clinical philosophy Agencies are likely to want to do all their own work Cenpatico has rules that make it challenging (Respite rules) System still operates in a “choice” rather than “need”model Very complicated and somewhat untested system by Cenpaico

Plans to address change Hiring Utilization review specialist Will monitor children in out of home care Monitor referrals to other agencies Help move staff to a marked change in practice Provide what people need Training leaders Supervisors and Directors need to understand the system Similar to private healthcare world

Increase and improve internal competence Development of infant and early childhood services Blake Foundation provided over 1M dollars of services to our children last year Hiring an IECP expert to train, plan and improve competence Goal is to be 75% self sufficient by January 1. (lofty) Examine service delivery for children on the Autism Spectrum Explore opportunities to sub-contract with specialty services Psychological evaluations Increase skill set in Case Managers (especially High Needs) Utilize Foster families to provide overnight Respite