1. Value Based Contracts
Cenpatico

2. 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

3. 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

4. PMPM payment

5. 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

6. Penetration rate

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

8. 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

9. 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

10. Services that we don’t provide to our families

11. Outside Scope of Work

12. 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

13. 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

14. 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

15. 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