The Arizona Health Care Cost Containment System (AHCCCS) has issued their Strategic Plan for 2014-2018 complete with six focus areas. The focus areas include delivery system alignment and integration, payment modernization, tribal care coordination, program integrity, health information technology, and quality assessment and improvement strategies.
AHCCS has been able to register, validate, and pay 1,970 eligible professionals and 66 eligible hospitals since the program opened in July 2011. The Medicaid payments have totaled over $132,665,669 million. Medicare has paid an additional 3,689 eligible professionals $60,689,275 and the total payments made to hospitals as of April 2013 was $247,815,252.
The development of HIE infrastructure in the state is being accomplished in several ways. AHCCCS continues to serve on the Health-E Connection Board which is focused on policy development, outreach, and education to providers. In addition, the Health Information Network of Arizona Board, (HINAZ) has won a state contract to build a provider directory and operate an HIE. AHCCCS encourages all of its health plans to join the HIE and expects service to start sometime in 2013.
In 2012, Governor Brewer informed the Obama administration that the state will not pursue the creation of a state-based Health Insurance Exchange. The state will participate in a FFM as outlined in the ACA and has completed planning and designing an IT infrastructure that is moving forward with the Health-e-Arizona Plus system.
The Health-e-Arizona Plus October 1, 2012 Phase I implementation will include a web-based eligibility system for applications, determinations, renewals, changes, and health plan enrollment for all AHCCCS programs except for the Arizona Long Term Care System (ALTCS). The system also includes similar functionality for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and some local health programs.
Phase I includes portals for consumers, community assisters, and state workers while it provides support through a variety of educational tools. The system includes account set up notices, document management, on-line appeals requests, workload management tools, and premium billing. The system will integrate with federal and state data systems, call centers, provide for interactive voice response, and provide the ability to contact the SNAP and TANF electronic benefit transfer vendors.
Health-e-Arizona Plus Phase II after October 2012 through December 2015 will include the remaining back-end functions in the AHCCCS and DES legacy systems. Health-e-Arizona Plus Phase II will incorporate applications, determinations, renewals, changes and health plan enrollment for ALTCS, and enhanced fraud detection.
The Office of Medical Policy, Analytics and Coding (OMPAC) is going to be responsible for the AHCCCS Data Warehouse to provide information that is easily accessible and reliable. AHCCCS will work with internal and external data analytics experts over the next year to develop the organization’s capacity to turn solid information into efficient actions. In addition, OMPAC staff will work to determine what information is most often required so that a set of standard reports based on the organization’s focused areas can be developed.
The state of Arizona has been working on providing behavioral health services since statistics show that in Arizona, the number of people that die 25 years earlier than the general public from serious mental illness is greater in Arizona.
AHCCCS has worked with the Arizona Department of Health Services (ADHS) in their Division of Behavioral Health Services (DBHS) to create a specialty Regional Behavioral Health Authority (RBHA) model with expanded responsibility for Medicaid members that have a Serious Mental Illness (SMI) in Maricopa County.
The integrated RBHA model will be fully responsible to deliver and pay for coordinated and integrated behavioral and physical healthcare for members with SMI. On January 8, 2013, ADHS received proposals for the Acute Care and Behavioral Health Care Integration Request to help the SMI population in Maricopa Country but the new RBHA contract award for the county is currently being protested.
Greater Arizona (all counties except Maricopa) RBHA procurement is slated to begin with start dates of October 1, 2015. AHCCCS will work with DBHS to expand the SMI integration model to other counties and other behavioral health populations as part of this procurement process.
Go to www.azahcccs.gov/shared/Downloads/StrategicPlan_14-18.pdf to view the AHCCCS Strategic Plan.