1. Digging Into the Arizona Behavioral Health Payment Reform Self-Help Toolkit Dale Jarvis, CPA www.djconsult.net

2. The Arizona Toolkit 2 http://azpaymentreform.weebly.com/

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4. Two Discussion Topics The Arizona AHCCCS Value-Based Purchasing Design Organizing for Payment Reform within Your Organization 4

5. 5 30% Waste

6. “Shocking News” Medicare Payment Reform is Working – 54 Medicare ACOs: $254 Million Savings in FIRST YEAR – 23 Pioneer ACOs: $147 Million Savings in FIRST YEAR – Physician Group Practice Demonstration: $108 Million Savings over the 5 Year Program 6

7. “More Shocking News” January 2015 Announcement – Moving 50% of all Fee for Service Medicare Payments into Alternative Payment Models (not Fee for Service) by 2018 – Moving 90% of all Fee for Service Medicare Payments into APMs or Fee for Services Plus Pay for Performance by 2018 7

8. Arizona is on the Heels of CMS Arizona AHCCCS: Medicaid Contractors must implement Value Based Purchasing for the year beginning 10/1/2015 – 15% of Long Term Care System Elderly and Physical Disability Program Payments – 20% of Children’s Rehabilitative Services – 20% of Acute Care Services – 5%(20%)(?%) of RBHA-Behavioral Health Services With a plan to increase the percentages each year. 8

9. The Arizona AHCCCS Value- Based Purchasing Design 9

10. Value-Based Purchasing Defined Payors hold Providers Accountable for both the Cost and Quality of Care Using Strategies to Reward Providers for: – Reducing Inappropriate Care and – Providing High Value Care that is Patient Centered, Clinically Effective, and Cost Effective – That can result in Bending the Cost Curve And sometimes using Strategies to put Providers at Risk if the above isn’t accomplished 10

11. High Value Care Defined 11 Achieves individual and systemwide outcomes Costs less than alternatives with comparable outcomes Accessible care provided by staff that communicate well..

12. What to Measure? Survey of 7 Federal Quality Programs 250 Quality Measures relevant to individuals with BH Disorders 12

13. AHCCCS Acute Care P4P Measures 13

14. AHCCCS Acute Care P4P Measures 14

15. AZ VBP At-A-Glance 15

16. Deconstructing the AZ VBP Menu 16

17. Deconstructing AZ VBP – Blue Boxes Most of the Payment will not be value-based – (typically some version of Fee for Service) Plus a Pay for Performance (P4P)(Bonus) Layer if the provider meets certain quality and/or cost targets – Primary Care Incentives for Primary Care Providers – Performance-Based Contracts for Other Providers 17

18. Deconstructing AZ VBP – Green Boxes Dump Fee for Service and Block Payment Replace with a Case Rate – Payment of a flat fee per patient for a predefined episode at a specific level of care – Regardless of how many services and how much money was spent – May involve service providers from multiple organizations Should also include a P4P Layer 18

19. Deconstructing AZ VBP – Red Boxes Capitation Definition: – An agreed upon payment from the Health Plan to a Provider Organization, including Accountable Care Organizations – Paid in the form of a Per Member Per Month (PMPM) for each enrollee who is assigned to the Provider Organization/ACO – In return for the PMPM, the Provider/ACO will assure timely access to a predefined set of health benefits and quality agreements, – And the payment flows regardless of whether an individual uses services or not 19

20. Deconstructing AZ VBP – Red Boxes Capitation Definition + Performance-Based Contracts: AHCCCS says you can’t pay Capitation without a P4P Layer Shared Savings: Use of a tracking system to determine whether your care reduced costs; if so, you get a share Shared Risk: You get to share in the Savings and any Losses. 20

21. One Size Does Not Fit All 21

22. Organizing for Payment Reform within Your Organization 22

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26. One Plan, Two Levels of Work 26

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28. National BH Performance Measurement Individual Outcomes System Outcomes 28

29. Individual Outcomes University of Washington AIMS Center 29

30. Treatment to Target 30

31. Portland Oregon’s T2T Project 31

32. Value-Based Purchasing Design 32

33. Two Value-Based Purchasing Elements 33

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38. One Size Does NOT Fit All 38

39. Pay for Performance 39

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45. What’s Next Give us Feedback! 45

46. What’s Next RBHA Value-Based Purchasing Plans coming soon. Additions to the Toolkit based on the VBP Plans. RBHA-Specific VBP Provider Success Checklists RBHA-Specific VBP Provider Success Content A set of webinars on the above material 46

47. What Else? 47