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 Project Summit April 18, 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 2  AHCCCS Dual Eligible Population  Proposal Overview  AHCCCS Next Steps

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 AHCCCS Dual Eligible Population

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 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 4

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 DUAL ELIGIBLE MEMBERS MEDICARE ENROLLMENT January 2012

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 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

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 Dual Member Integration Proposal

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 Federal Opportunity  CMS has created Medicare-Medicaid Coordination Office (Office for the Duals) http://www.cms.gov/medicare- medicaid-coordination/01_Overview.asphttp://www.cms.gov/medicare- medicaid-coordination/01_Overview.asp  Office provided with some new flexibilities as part of the ACA  CMS issued opportunity in July 2011 for states interested in pursuing Dual Integration Demonstration http://www.azahcccs.gov/reporting/legislation/Integration/Int egration.aspx http://www.azahcccs.gov/reporting/legislation/Integration/Int egration.aspx  Regular discussions since then – project fluid – more flexible

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  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

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  Plan Selection ALTCS E/PD: Use existing ALTCS Contractors Members with Serious Mental Illness in Maricopa County: Maricopa RBHA required to be Demo plan 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

11. “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 11 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

12. “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 12 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

13. “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 13 AHCCCS Demonstration Proposal Care Model Overview  Build on existing AHCCCS system  Robust network and monitoring  Behavioral health carve-out for Acute population Behavioral health will be coordinated through RBHAs Demonstration plans will be required to coordinate with RBHAs Contract to formalize coordination and data sharing responsibilities

14. “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 14 AHCCCS Demonstration Proposal Care Model Overview  Single benefit package for duals All Medicare benefits All Medicaid State Plan benefits All Medicaid 1115 Waiver benefits, including home and community based services for the ALTCS population Behavioral health services Medicare Supplemental benefits (proposed)

15. “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 15 AHCCCS Demonstration Proposal Stakeholder Engagement  Important piece of Demonstration  Ongoing key to planning and implementation  Continue to outreach Web/email Mailings/fliers at community locations In-person meetings

16. “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 16 AHCCCS Demonstration Proposal Stakeholder Engagement  Education will be key to success  Opt-out option very important  Medicare supplemental benefits  Continuity of care and coordination with current providers  Simplification

17. “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 17 AHCCCS Demonstration Proposal Beneficiary Protections  Opt-out and choice of plan  Experienced member transition processes Providers Prescription drugs  Maintaining current level of benefits  Streamlining grievance and appeals

18. “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 18 AHCCCS Demonstration Proposal Financing and Payment  Capitated Financial Alignment model  Blended rate for all Medicare and Medicaid benefits determined by State and CMS  Plans will receive separate payments from State and CMS  Savings from integration will be shared between CMS and the State

19. “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 19 AHCCCS Demonstration Proposal Financing and Payment  Rates and savings still being determined  Savings will be nominal AHCCCS managed care model High penetration of members in home and community based settings 60% duals in Medicare Advantage plans 1/3 of duals aligned with same plan  Actuarially sound rates  Adopt current Medicaid rate setting processes

20. “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 20 AHCCCS Demonstration Proposal Application of Upfront Savings  Further discussion needed  Exploring ways to invest savings in care model Extend the benefit package to include dental, vision or hearing benefits currently covered under Medicare Advantage plans as part of their supplemental benefits package Reduced prescription drug co-pays Provide care managers who can assist members with questions and education

21. “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 21 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

22. “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 22 AHCCCS Demonstration Proposal Expected Savings  Inpatient reductions of avoidable preventable admissions and avoidable readmissions  Skilled Nursing Facility reductions  Emergency room reductions  Other Medicare medical services

23. “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 23 AHCCCS Demonstration Proposal State Infrastructure  Mandatory Medicaid managed care for duals  Experienced managed care infrastructure Monitoring managed care organizations Developing policies and contractual requirements Oversight and compliance Rate setting Encounter collection and data analysis Clinical quality management Medical management

24. “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 Next Steps

25. “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 25 AHCCCS Demonstration Proposal  Draft proposal on website for 30 day comment period  Comment period closes May 17 th at 5:00pm By email: duals@azahcccs.govduals@azahcccs.gov By mail: Arizona Health Care Cost Containment System ATTN: Office of Intergovernmental Relations 801 E. Jefferson Street, MD 4200 Phoenix, Arizona 85034

26. “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 26 AHCCCS Demonstration Proposal  All feedback welcome  Specific areas Target population Enrollment methodology Delivery of behavioral health services to the Acute Care population Supplemental benefits Beneficiary protections and ongoing stakeholder engagement Financing and payment model Application of State savings Implementation strategy

27. “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 27 AHCCCS Demonstration Proposal  May 2012: Review proposal comments  May 2012: Submit final proposal to CMS  May 2012: CMS makes proposal available for additional 30 day comment period then reviews for approval  Pending proposal approval, State will negotiate integration of Medicare/Medicaid benefits and requirements with CMS  Continued stakeholder engagement  3-way contracts signed with CMS, State, and Plans