1. AHCCCS Update

2. AHCCCS Care Delivery System 2 Reaching across Arizona to provide comprehensive quality health care for those in need

3. Medicaid Restoration Reaching across Arizona to provide comprehensive quality health care for those in need 3 12/1/20131/1/2015Change Prop 204 Restoration67,770275,743 207,973 Adult Expansion037,369 KidsCare46,7611,665 -45,096 Family Planning5,1050 -5,105 AHCCCS for Families & Children (1931) 672,135682,456 10,321 All Other505,379624,720 119,341 Total Enrollment1,297,1501,621,953 324,803

4. AHCCCS Enrollment Growth 4 Reaching across Arizona to provide comprehensive quality health care for those in need

5. Renewal Activity Reaching across Arizona to provide comprehensive quality health care for those in need 5

6. Restoration/Expansion Actual to 2013 Estimates 6 Reaching across Arizona to provide comprehensive quality health care for those in need

7. AHCCCS/DES Call Volume 7 Reaching across Arizona to provide comprehensive quality health care for those in need

8. Impact of Enhanced Match (Millions) Funding Source for Adults 0-100% FY 16 Current Law – 90% match FY 16 – Traditional Match Tobacco Funds156.4 Hospital Assessment 245.90.0 General Fund114.3746.8 Federal Funds2,630.62,244.1 Total Funds3,147.3 8 Reaching across Arizona to provide comprehensive quality health care for those in need

9. FY 15 & FY 16 Executive Budget How big is the problem? o FY 15 - $160 m o FY 16 - $533.7 m AHCCCS Recommendation o 3% Provider Rate Reduction – in FY 15 o DD Provider rates exempt o Flexibility for AHCCCS in analysis o DSH Changes o Some funding included for ALTCS Dental 9 Reaching across Arizona to provide comprehensive quality health care for those in need

10. Spending by Provider Type 10 Reaching across Arizona to provide comprehensive quality health care for those in need

11. AHCCCS Budget Rec Governor’s Initiative for Administrative Simplification with BHS and AHCCCS fully effective July 1, 2016 Current Structure is redundant – AHCCCS oversees BHS No services are cut and no change in how services are delivered All existing contracts (and new awards) remain in place – moves existing RBHA contracts to AHCCCS for oversight This transition will be seamless to those who need services and the family members that support them We will be thoughtful in transition and work to bring the best of both organizations together We will be reaching out to stakeholders for input as part of transparent process 11 Reaching across Arizona to provide comprehensive quality health care for those in need

12. Total AHCCCS System Health Plan Profits 12 Reaching across Arizona to provide comprehensive quality health care for those in need

13. ED Utilization: % of Total Paid Amount 13 Reaching across Arizona to provide comprehensive quality health care for those in need

14. Hospital Uncompensated Care and Net Operating Profits, 2011-2013 ($ in millions) 14 Reaching across Arizona to provide comprehensive quality health care for those in need

15. 15 Growth in National Health Expenditures and Gross Domestic Product (GDP), 1985-2013 SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group, U.S Department of Commerce, Bureau of Economic Analysis and National Bureau of Economic Research, Inc. Annual Percent change July 1990- March 1991 Recession March 2001- November 2001 Recession Calendar Years December 2007-June 2009 Recession

16. Payment Modernization Success Incremental movement in the system to alternative payment structures Alignment across the AHCCCS measures Implementation of New APR-DRG structure Work being done by plans to address low E- prescribe rankings Ready for 4-1-15 FQHC PPS Implementation Developing Strong Learning Culture SIM Design Funding 16 Reaching across Arizona to provide comprehensive quality health care for those in need

17. Payment Modernization Expectations Accelerate Incremental growth in new payment structure – Continue to move discussion to Value – Dr. Porter – Focus networks and contract incentives on high value providers Move APR-DRGs and other payments to better reflect Value 50% of our spend in Value by 2018 17 Reaching across Arizona to provide comprehensive quality health care for those in need

18. Integration PopulationBH FundingAcute FundingStatus 18,000 Members with SMI $405 m$112 MImplemented April 1, 2014 17,000 CRS$25 m$126 m CRS - $59 m Acute Implemented 10-1-2013 17,000 Members with SMI – Greater AZ $419 m$117 mPlanned 10-1-2015 60,000 Duals – 45%Ongoing 80,000 Acute Duals$25 m$144 Medicaid - $--- Medicare Planned 10-1-2015 18 Reaching across Arizona to provide comprehensive quality health care for those in need

19. Integration Expectations Successful 10-1-2015 Transitions SB 1375 Report due to legislature looking at delivery system for CMDP DD Acute Contracts for 10-1-16 – look at integration of BH – DSNP Requirements Continue to pursue Seamless Conversion Support Sustainability efforts for DSNP 19 Reaching across Arizona to provide comprehensive quality health care for those in need

20. Members with High Needs High Costs System moved to meet 1-1-15 Requirement for 20 members in active care coordination Individual success stories – data sharing Expectations Pursue Care Coordination/Management regardless of open episode of care Collaborative Effort – State – Plans - RBHAs Additional requirements that work to scale up efforts 20 Reaching across Arizona to provide comprehensive quality health care for those in need

21. Blind Spot Data Successfully started sharing data AHCCCS Successfully collecting more data Expectations Want to see broader leverage of data sources o BH Data – Physical Health Data o Medicare Data o I.H.S & 638 Data 21 Reaching across Arizona to provide comprehensive quality health care for those in need

22. Expectations Consumer Engagement - 10-1-16 Waiver Increased Copays – Oct 1. 2015 (?) Supplemental Rebates – AHCCCS selectively will be pursuing exclusive agreements – Start with Hep C Autism Services Focus Efforts on Prescription Drug Abuse Continued collaboration on AIHP efforts Continued focus on Justice System transitions Transparency – MCO Report Card – Provider financials Data Security Ongoing support for HIT 22 Reaching across Arizona to provide comprehensive quality health care for those in need

23. AHCCCS Procurements 10-1-15 Greater AZ RBHA Transition 10-1-16 DD Acute Contracts 10-1-17 ALTCS Contracts 10-1-18 Acute Care 10-1- ? RBHA 23 Reaching across Arizona to provide comprehensive quality health care for those in need