1. AHCCCS Contractor Update Meeting: CYE 16 Value-Based Purchasing Policy – Sneak Peak
March 18, 2015
Shelli Silver

2. Rebranding
Payment Reform, Payment Modernization, Gain Sharing, Shared Savings…
Now: Value-Based Purchasing (VBP)
Aligning incentives
Promoting quality
Improving member outcomes
Improving provider performance
Slowing/lowering costs
Reaching across Arizona to provide comprehensive quality health care for those in need

3. CYE 16 VBP Policy – Acute Care
At least 20% of total medical spend must be subject to a contract utilizing a VBP strategy
Strategies include:
Primary Care Incentives
Performance-based Contracts
Bundled/Episode Payments
Shared Savings
Reaching across Arizona to provide comprehensive quality health care for those in need

4. CYE 16 VBP Policy – Acute Care cont.
Shared Risk
Capitation + Performance-based Contracts
At least 25% of the 20% requirement shall be with Primary Care Providers
MCOs will account for “limited” cost of care or “total” cost of care for each contract
provider can only impact direct and limited costs attributed to members, or the total cost of care attributed to members
Reaching across Arizona to provide comprehensive quality health care for those in need

5. CYE 16 VBP Policy – Acute Care cont.
The same dollars can not be counted under multiple contracts
One contract can not be counted under multiple strategies
Contracts must be executed by February 1, 2016
AHCCCS is developing a structured system for non-encountered VBP payments
Reaching across Arizona to provide comprehensive quality health care for those in need

6. CYE 16 VBP Policy – Acute Care cont.
1% of capitation will continue to be assessed via a reconciliation
Same quality measures will apply
MCOs are not limited to the quality measures in Policy as part of VBP strategies
Intent for VBP contracting for future years’
35% in 2017
50% in 2018
Reaching across Arizona to provide comprehensive quality health care for those in need

7. CYE 16 VBP Policy Timeline
Acute Care draft Policy to be released on or around April 1, 2015
Comment period with deadline to be provided
All other AHCCCS lines of business to follow with draft policies in April/May 2015
Reaching across Arizona to provide comprehensive quality health care for those in need