1. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System AHCCCS Dual Integration AHCCCS Managed Care Organization Update Meeting May 16, 2012

2. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System Dual Enrollment 119,832 FFS American Indian Health Plan 9,414 ALTCS – DD 5,280 ALTCS – EPD 21,090 Alignment 6,466 31% Acute 84,048 Alignment 32,816 39% AHCCCS Dual Enrollment as of January 2012 2

3. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 3 AHCCCS DUAL ELIGIBLE MEMBERS MEDICARE ENROLLMENT January 2012

4. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 4 Dual Eligible Member Complexity and Fragmentation  Problems with Fragmentation Navigating multiple systems adds confusion for members Lack of real-time clinical data frustrates those trying to help manage member – results in higher costs and poorer outcomes Diffused accountability = No accountability Fragmentation incentivizes cost shifting – not care coordination

5. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 5 AHCCCS Demonstration Proposal  3 Year Demonstration  January 1, 2014 Statewide Implementation  3 way contract – CMS – State – Plan  3 Populations ALTCS E/PD: 21,000 Acute members with Serious Mental Illness in Maricopa County: 7,000 Acute: 77,000  Still many questions – requires flexibility

6. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 6 AHCCCS Demonstration Proposal  Plan Selection ALTCS E/PD: Use existing ALTCS Contractors Members with Serious Mental Illness in Maricopa County: Maricopa RBHA required to be Demo plan or D-SNP Acute: Plan selection through upcoming RFP issued Fall 2012  All plans will be required to meet additional CMS requirements including: Demonstration specific application Part D formulary approval Model of Care approval

7. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 7 AHCCCS Demonstration Proposal Vision and Rationale  Passive (automatic) enrollment into integrated plan with opt-out choice to Original Medicare  Build on the current AHCCCS managed care structure  Improve current D-SNP model Ongoing automatic enrollment Align administrative processes

8. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 8 AHCCCS Demonstration Proposal Vision and Rationale  Members would have one point of contact for all services – Prescription drugs, all Medicare and Medicaid benefits  Providers would have one point of contact for prior authorizations and billing  Would allow plans to better coordinate care by having access to all member information  Integrates Admin processes – Appeals, marketing, quality measures, reporting, oversight

9. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 9 AHCCCS Demonstration Proposal Expected Outcomes  Improved outcomes, including improved health status of dual eligibles enrolled in the Demonstration  More efficient and effective utilization of services  A reduction in cost-shifting between Medicare and Medicaid plans  Improved access to information and data  Consolidation of accountability for care  A reduction in duplication of services  An increase in enrollee satisfaction, leading to an increase in compliance  Administrative efficiencies

10. “Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment System 10 AHCCCS Demonstration Proposal Upcoming Dates  April 2012: Draft proposal published for comment – Comments due TOMORROW by 5:00pm!  May 30, 2012: Submit final proposal to CMS  June 2012: CMS makes proposal available for additional 30 day comment period  June 8: Public Meeting to discuss final proposal submission  Summer/Fall 2012: State begins negotiation with CMS to integrate Medicare and AHCCCS requirements and finalize Demonstration  Spring 2013: 3-way contracts signed with CMS, State, and Plans  Ongoing stakeholder engagement