PresentationTribalConsultationPresentation09222011.Pdf Form

TRIBAL CONSULTATION SEPTEMBER 22, 2011 A DIALOGUE WITH: LAURA NELSON M.D. (ADHS) & KRISTIN FROUNFELKER (AHCCCS) Arizona's Proposal for a New Medicaid Model: Serving Individuals with Serious Mental Illness through Integrated Healthcare Homes

Why Healthcare Integration? y Improve lifespan and healthcare outcomes { Persons with Serious Mental Illness (SMI) die 25 to 30 years earlier than general population y Control costs { 60% of Medicaid’s highest cost beneficiaries with disabilities have co- occurring physical and behavioral health conditions { Current healthcare system is unsustainable y Strengthen the focus on screening, prevention, early intervention, care management, patient education, & wellness y Support the national movement and focus

First Steps in Planning for Integrated Care y Starting and nurturing the dialogue Ù CHCs, FQHCs, IHS, Tribal Health Programs, Urban Indian Health Programs—many have been providing integrated care for decades Ù Existing partnerships between Regional Behavioral Health Authorities (RBHAs) and AHCCCS Health Plans Ù Milbank Memorial Fund Conference in January 2011 Ù Other states and national experts y Identifying key system partners Ù Members and Family members Ù T/RBHAs Ù Health Plans Ù Behavioral Health and Physical Health Care Providers

| Including IHS, Tribal Health Programs Operated under P.L. 93-638,

Urban Indian Health Programs (I/T/U)

First Steps in Planning for Integrated Care y Awarded Section 2703 Planning Grant y Obtained support and commitment from Executive y Developed structure to drive change—Interagency Steering Committee: ÙADHS/DBHS and AHCCCS are co-leads ÙEstablished foundational principles ÙEstablished vision for Specialty RBHA with SMI Health Homes ÙUtilizing consultants as necessary (research, data analysis, stakeholder input…)

Foundational Principles

A reason system transformation and improved coordination of health care are foundational principles… Let’s review the current system

Vision for Specialty RBHA y One (1) or more at-risk managed care organizations (MCOs) to act as a Specialty RBHA with SMI Health Homes Ù Become a Medicare Special Needs Plan (SNP) Ù Start with Maricopa County (begin October 1, 2013) Ù Consider expansion to other geographic service areas and behavioral health populations (kids, adults without SMI) y Expanded responsibility for Title XIX adults with SMI
Ù Fully integrate at administrative and service delivery level Ù Provide all medically necessary behavioral health and physical health care services through the use of health homes Ù Meet all CMS requirements for health homes Ù Coordinate and manage benefits for dual eligible Title XIX members with SMI Ù Coordinate care using electronic health records and health information technology (HIT) which provides information to measure system and member-level outcomes

Vision for Specialty RBHA… some things don’t change y Provide all behavioral health services using current model to TXIX GMH/SA/CA populations (RBHAs + Acute Care AHCCCS Health Plans) y Provide Non-TXIX reimbursable services to TXIX members y Provide services for non-TXIX eligible members *subject to funding allocations and ADHS contract expectations

Vision for SMI Health Homes y Multidisciplinary team responsible for delivering physical and behavioral health services y Multidisciplinary team responsible for both member and population outcomes y Evidenced based practices used for screening, prevention, wellness, care management, disease management and Recovery programs y Care coordinated through technology and information sharing systems

Behavioral Health Clinic Care coordination site Primary Care Services Peer Support Employment support Housing support Behavioral Health Services Vision for SMI Health Homes Specialty Care Services

Current Activities…. y Data analysis Ù Acute care + behavioral health care + Medicare data Ù Utilization patterns and profiling Ù Diagnostics & demographics of the population y Stakeholder input Ù Members and family members Ù Behavioral health and physical health providers Ù Managed care organizations

| RFI submissions and presentations

Ù Tribes and Indian Health System (I/T/U) Ù Other system partners September

The Next 6 Months… y Establish requirements/definitions for SMI health homes Ù Services Ù Team members Ù Best/promising practices to be used Ù Outcomes Ù Information technology y Consider stakeholder input/recommendations y Ongoing guidance from CMS y Consultation with SAMHSA

The Next 12 Months and beyond… y RFP y State Plan Amendment y Policies y Costs; billing codes; reimbursement y Confidentiality; HIPAA regulations y Provider/workforce Ù Licensing; credentialing; privileging Ù Provider network development y Training y EHR/EMR/HIE; technology; sharing of data

Throughout This Process… y Preserve Recovery y Peer and Family voice and participation in program design y Maintain strong and effective communication { Transparency { Seek public buy-in and support { Inclusion { http://www.azdhs.gov/

Discussion/Consultation y What recommendations do you have in terms of care coordination given the choices American Indians have for health care? y How can we continue this dialogue after today?

THANK YOU FOR YOUR PARTICIPATION TODAY HTTP://WWW.AZDHS.GOV/