“Reaching across Arizona to provide comprehensive quality health care for those in need” Arizona Health Care Cost Containment System Administrator Meeting Quality Update March 19, 2014

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS  CHPRA legislation required State Medicaid programs to conduct a CAHPS member satisfaction survey by December 2013 for the CHIP (KidsCare) population  The AHCCCS 2011 Demonstration Waiver requires AHCCCS to conduct the CAHPS survey for: KidsCare in 2013 and at the end of the Waiver (2015) SMI Integrated Population - pre-integration, mid-Waiver and at the end of the Waiver CRS Integrated Population - pre-integration, mid-Waiver and at the end of the Waiver  Goal: The goal of the CAHPS Health Plan Survey is to provide performance feedback that is actionable and that will aid in improving overall member satisfaction

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Baseline Measurement  The 2013 CAHPS results represent a baseline assessment of member’s (or their parents’/caretakers’) satisfaction with the AHCCCS program across the following lines of business: KidsCare Acute Seriously Mentally Ill (pre-integration) Children’s Rehabilitative Services (pre-integration)  The CAHPS was completed by the CMS External Quality Review Organization, Health Services Advisory Group

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Survey Tool  In 2012, the Agency for Healthcare Research and Quality (AHRQ) released the CAHPS 5.0 Medicaid Health Plan Surveys  The National Committee for Quality Assurance (NCQA) introduced new HEDIS versions of the Child Health Plan Surveys in August 2012, which are referred to as the CAHPS 5.0 Child Medicaid Health Plan Surveys  There were no changes made to the four CAHPS global ratings: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor, and Rating of Specialist Seen Most Often  This allowed comparisons to national data to be performed for all global rating categories

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Composite Measures  Getting Needed Care  Getting Care Quickly  How Well Doctors Communicate  Customer Service  Shared Decision Making  Coordination of Care  Health Promotion and Education  Children with Chronic Conditions

“Reaching across Arizona to provide comprehensive quality health care for those in need” Scoring Methodology  The results of the health plan surveys were scored using the NCQA Star Ratings National Medicaid results. The rating scale is as follows:  ***** 90 th Percentile or above  ****75 th – 89 th Percentile  ***50 th – 74 th Percentile  ** 25 th – 49 th Percentile  * Below 25 th Percentile  For the children’s measures, the rates and proportions were compared to NCQA Child Medicaid Quality Compass data

“Reaching across Arizona to provide comprehensive quality health care for those in need” KidsCare CAHPS Results  Results are at the Program Level only  The KidsCare program scored at or above the national average on seven measures: Rating of Health Plan Rating of All Health Care Rating of Specialist Seen Most Often Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service

“Reaching across Arizona to provide comprehensive quality health care for those in need” KidsCare CAHPS Opportunities for Improvement  Based on the results of the NCQA comparisons, priority assignments were derived for each measure  The following are the high priority areas for KidsCare: Getting Care Quickly How Well Doctors Communicate Rating of Specialist Seen Most Often

“Reaching across Arizona to provide comprehensive quality health care for those in need” KidsCare High and Low Percentile Results  KidsCare scored at or above the 90 th percentile on one measure: Rating of All Health Care  KidsCare scored below the 25 th percentile on none of the measures

“Reaching across Arizona to provide comprehensive quality health care for those in need” Acute Care Program Adult and Child Medicaid CAHPS Results  Acute Care Program: Results are at the Program Level and the Health Plan Level Arizona Physicians IPA Bridgeway Health Solutions Department of Economic Security/Comprehensive Medical and Dental Program (DES/CMPD) Care 1 st Health Plan of Arizona Health Choice Arizona Maricopa Health Plan Mercy Care Plan Phoenix Health Plan University Family Care Acute Care Program Aggregate

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Adult Composite Results – NCQA Comparison Contractor Name Rating of Health Plan Rating of all Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Acute Care Program *** *** ** *** Arizona Physicians IPA ***** ***** **** ***** Bridgeway Health Solutions * ** **** *** Care 1 st Health Plan of Arizona ** *** ** * Health Choice Arizona * *** * * Maricopa Health Plan ** *** ** *** Mercy Care Plan *** *** ** *** Phoenix Health Plan ** * * **** University Family Care **** ***** *** ***** 2.622

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Adult Composite Results – NCQA Comparison Contractor Name Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service Acute Care Program *** ** *** **** Arizona Physicians IPA **** **** **** **** Bridgeway Health Solutions *** *** **** *** Care 1 st Health Plan of Arizona ** ** *** **** Health Choice Arizona *** ** ** *** Maricopa Health Plan **** ** ** ***** Mercy Care Plan *** * ** **** Phoenix Health Plan ** ** ** ***** University Family Care **** ** **** ***** 2.564

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Plan Satisfaction Ranking Based on Number of Adult Measures at or Above the NCQA National Average Health PlanNumber of Measures At or Above the National Average Arizona Physicians IPA9 Acute Care Program Overall7 Bridgeway Health Solutions7 University Family Care7 Health Choice Arizona4 Care 1 st Health Plan3 Maricopa Health Plan3 Mercy Care Plan3 Phoenix Health Plan3

“Reaching across Arizona to provide comprehensive quality health care for those in need” Adult Acute Care Health Plan NCQA Comparison Highlights Arizona Physicians IPA Bridgeway Health Solutions Care 1 st Health Plan of Arizona Health Choice Arizona University Family Care ↑ Rating of Health Plan ↓ Rating of Health Plan ↓ Health Promotion and Education ↓ Rating of Health Plan ↑ Rating of Health Plan ↑ Rating of All Health Care ↑ Coordination of Care ↑ Rating of Specialist Seen Most Often ↑ Rating of Personal Doctor ↑ Health Promotion and Education ↑ Statistically better than the Acute Care Program average ↓ Statistically worse than the Acute Care Program average

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Child Composite Results – NCQA Comparison Contractor Name Rating of Health Plan Rating of all Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Acute Care Program **** ***** **** **** Arizona Physicians IPA ***** ***** ***** ***** Bridgeway Health Solutions ** ***** **** * Care 1 st Health Plan of Arizona *** ***** **** ***** DES/CMDP* ***** **** ** Health Choice Arizona *** *** **** **** Maricopa Health Plan **** ***** **** **** Mercy Care Plan ***** ***** ***** **** Phoenix Health Plan **** ***** **** ***** University Family Care **** ***** ***** *** 2.593

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Child Composite Results – NCQA Comparison Contractor NameGetting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service Acute Care Program*** 2.44 ** ** **** Arizona Physicians IPA***** ** *** **** Bridgeway Health Solutions *** *** *** **** Care 1 st Health Plan of Arizona *** * * **** DES/CMDP Customer service had fewer than 100 respondents ***** ***** **** ***** Health Choice Arizona*** ** * *** Maricopa Health Plan**** * * **** Mercy Care Plan*** ** *** **** Phoenix Health Plan*** *** ** ***** University Family Care**** *** *** **** 2.544

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Plan Satisfaction Ranking Based on Number of Child Measures at or Above the NCQA National Average Health PlanNumber of Measures At or Above the National Average Phoenix Health Plan9 Acute Care Program Overall8 Arizona Physicians IPA8 Bridgeway Health Solutions8 Mercy Care Plan8 University Family Care8 Care 1 st Health Plan6 DES/CMDP6 Health Choice Arizona6 Maricopa Health Plan6

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Plan Satisfaction Ranking Based on Number of Child Measures at or Above the NCQA National Average Health PlanNumber of Measures Above the 90 th Percentile Number of Measures Below the 25 th Percentile Acute Care Program Overall10 Arizona Physicians IPA50 Bridgeway Health Solutions11 Care 1st Health Plan of Arizona 22 DES/CMDP41 Health Choice Arizona02 Maricopa Health Plan12 Mercy Care Plan30 Phoenix Health Plan30 University Family Care20

“Reaching across Arizona to provide comprehensive quality health care for those in need” Child Acute Care Health Plan NCQA Comparison Highlights Health PlanRating of Health Plan Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Needed Care Getting Care Quickly How Well Doctors Communica te Customer Service Shared Decision Making Arizona Physicians IPA 74.4% ↑75.6% ↑76.4% 79.1% %93.7%85.9%58.6% Bridgeway Health Solutions 65.4% ↓65.6%73.2%67.1%82.3%91.5% ↑95.4% ↑89.6%60.4% Care 1 st Health plan of Arizona 69.2%69.6%74.0%83.5%80.6%84.5% ↓90.6%88.9%52.0% DES/CMDP * had fewer than 100 respondents 63.0% ↓71.0%73.9%66.3%*87.5%96.2% ↑94.3%93.6%* ↑52.8% Health Choice Arizona 68.2%63.4% ↓73.8%73.2%80.4%89.1%90.7%86.3%49.2% ↓ Maricopa Health Plan 73.9%67.9%73.2%76.0%85.7%80.4% ↓87.9% ↓87.1%53.8% Mercy Care Plan 73.8% ↑71.0%76.2%73.7%81.7%87.9%93.6%85.9%57.3% Phoenix Health Plan 70.8%69.1%74.2%73.8%85.8%90.1%91.9%91.9% ↑54.6% University Family Care 72.2%71.8%76.2%70.4%84.2%89.6%92.3%86.6%60.2%

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Results for the Seriously Mentally Ill (SMI) Program Pre-integration – reflects care in both the physical and the behavioral health plans Star RatingMeasure *Getting Care Quickly *How Well Doctors Communicate *Rating of All Health Care *Rating of Health Plan *Rating of Personal Doctor *Rating of Specialist Seen Most Often **Customer Service **Getting Needed Care ** 25 th – 49 th Percentile*Below 25 th Percentile

“Reaching across Arizona to provide comprehensive quality health care for those in need” Health Care Satisfaction Ranking Based on Number of SMI Measures at or Above the NCQA National Average  The SMI members cored their health care at or above the national average on two measures: Getting Needed Care Customer Service  The SMI members scored their health care below the national average on seven measures: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Care Quickly How Well Doctors Communicate Coordination of Care

“Reaching across Arizona to provide comprehensive quality health care for those in need” High and Low Percentile Scores of SMI Member CAHPS Survey Results  The SMI Program scored at or above the 90 th percentile on none of the measures  The SMI Program scored below the 25 th percentile on six measures: Rating of Health Plan Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Care Quickly How Well Doctors Communicate

“Reaching across Arizona to provide comprehensive quality health care for those in need” SMI Program’s Priority Assignments to Improve Member Satisfaction MeasureNCQA Comparisons (Star Ratings) Priority Assignments Getting Care Quickly*Top How Well Doctors Communicate *Top Rating of All Health Care *Top Rating of Health Plan*Top Rating of Personal Doctor *Top Rating of Specialist Seen Most Often *Top Customer Service**High Getting Needed Care**High

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Results for the Children’s Rehabilitative Services Program – NCQA Comparison Star RatingMeasure **Getting Care Quickly **How Well Doctors Communicate **Customer Service *Rating of Health Plan ** 25 th – 49 th Percentile*Below 25 th Percentile

“Reaching across Arizona to provide comprehensive quality health care for those in need” CRS Program CAHPS Comparison to NCQA Averages  Results reflect pre-integration member satisfaction with an acute, CRS and behavioral health Contractor  The CRS Program scored at or above the national average on eight measures: Rating of All Health Care Rating of Personal Doctor Rating of Specialist Seen Most Often Getting Needed Care Getting Care Quickly How Well Doctors Communicate Customer Service Coordination of Care  The CRS Program scored below the national average on one measures: Rating of Health Plan

“Reaching across Arizona to provide comprehensive quality health care for those in need” High and Low Percentile Scores of CRS Members’ CAHPS Survey Results  The CRS Program scored at or above the 90 th percentile on two measures” Rating of Personal Doctor Rating of Specialist Seen Most Often  The CRS Program scored below the 25 th percentile on one measure: Rating of Health Plan

“Reaching across Arizona to provide comprehensive quality health care for those in need” CRS Program’s Priority Assignments to Improve Member Satisfaction MeasureNCQA Comparisons (Star Ratings) Priority Assignments Rating of Health Plan*Top Customer Service**High How Well Doctors Communicate **High Getting Care Quickly**High Getting Needed Care***Moderate Rating of All Health Care *****Low Rating of Personal Doctor *****Low Rating of Specialist Seen Most Often *****Low

“Reaching across Arizona to provide comprehensive quality health care for those in need” CAHPS Survey Results Next Steps Contractors should review results and identify top priorities/opportunities to improve member satisfaction results Contractors should review positive results and determine what the drivers were for the results AHCCCS will notify Contractors of need to submit action plans to improve member satisfaction with its health plan AHCCCS will identify priorities to improve systemic member satisfaction AHCCCS will work with Contractors in the development of action plans to improve systemic member satisfaction