AHCCCS Acute RFP Public Input Meeting January 18,

AHCCCS Welcome Monica Coury Assistant Director Office of Intergovernmental Relations 2 January 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 3

January 18, 2012 AHCCCS Administration - Medical Care - Long Term Care - Healthcare Group Health Plans Program Contractors for Long Term Care State Agencies  DHS ·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 Americans  Emergency Services Arizona Health Care Cost Containment System 4

AHCCCS January 18, 2012 Acute Care Program Highlights The AHCCCS Acute Care Program will celebrate its 30 th 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

AHCCCS January 18, 2012 AHCCCS 6 Who Does AHCCCS Serve?* * As Of – 12/1/2011

AHCCCS January 18, 2012 AHCCCS POPULATION DEMOGRAPHICS – AS OF 12/1/2011 Total Population Percentages Child % Adult % Adult % Adult % Adult % Gender Male – 44.6% Females – 55.4% Ethnicity Percentages Asian /Pacific Island 1.92% Black6.78% Caucasian/White34.74% Cuban/Haitian0.01% Hispanic39.95% Native American10.21% Other0.45% Unknown5.94%

AHCCCS January 18, 2012 AHCCCS Population AHCCCS 8

January 18, 2012 Geographic Service Areas AHCCCS 9 Total Health Plan Enrollment = 1,118,800 83,04234,479 52, , ,261 50,646 33,846 Health Plan Enrollment GSA Number Acute 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 1 st, HCA, MHP, MCP, PHP MCP, UFC

AHCCCS January 18, 2012 AHCCCS 10 ContractorMembership Arizona Physicians IPA, Inc. (APIPA) 248,004 Bridgeway Health Solutions17,219 Care 1 st 49,783 Health Choice AZ185,354 Maricopa Health Plan53,665 Mercy Care Plan298,157 Phoenix Health Plan194,515 University Family Care72,103 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) 11

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 12

AHCCCS January 18, 2012 Contract Requirements – con’t. Program Integrity  Verification of service requirements  Cost avoidance reporting  Fraud and abuse 13

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) 14

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 15

AHCCCS January 18, 2012 AHCCCS Performance Measures Measures Exceeding the National Mean 10/1/2009 – 9/30/ % 96.3% 60.2% 88.4% 0.00% 20.00% 40.00% 60.00% 80.00% % Well Child Visits First 15 Months of Life Oral Health CareAppropriate Medication Use for Asthma AHCCCS Medicaid RateHEDIS 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 Access To PCP - Children's Access To PCP - 25 Mos - 6 Yrs AHCCCS KidsCare RateHEDIS Medicaid Mean Measures Exceeding the National Mean 10/1/2009 – 9/30/2010

AHCCCS January 18, 2012 Health Care Reform AHCCCS 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 January 18, 2012 Health Care Reform Estimates EligibleParticipants Exchange621,000479,000 AHCCCS431,000247,000 SHOP Exchange 1,822,000510,000 19

AHCCCS January 18, 2012 RFP Milestone Dates AHCCCS 20 ACTIVITYDATE 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  ing/RPFInfo/YH /YH14PublicMeeting.aspx ing/RPFInfo/YH /YH14PublicMeeting.aspx Address 