Arizona SIM Strategy

SIM Overview CMS established State Innovation Model (SIM) Initiative for multi-payer efforts around payment reform and health system transformation. Goal is to achieve statewide transformation for the preponderance of care delivered within the state and: o Improve health o Transform delivery system o Lower costs 2 Reaching across Arizona to provide comprehensive quality health care for those in need

SIM Overview – Delivery System Reform CMS has identified goals for delivery system transformation – states must work toward engaging providers in: 3 Reaching across Arizona to provide comprehensive quality health care for those in need Delivery System Transformation Providers participate in integrated or virtually integrated delivery models Providers use HIT to improve quality >80% of provider payments from all payers are value based, non-FFS structures Adequate healthcare workforce Every state resident has accountable (quality and cost) PCP Providers perform at top of license and board certification Care coordinated across providers and settings Consistently high performance in quality and cost measures High level of patient engagement (with quantifiable results) Population health measures integrated into delivery system Data used to drive health system processes

SIM Overview (ctd.) States may apply for design or test initiatives 2013 awards: o 6 states received total of $250 million for model tests o 3 states received pre-test assistance for design o 16 states received design awards 4 Reaching across Arizona to provide comprehensive quality health care for those in need

SIM Round 2 Round 2 applications due July 21, 2014 – Model Test award period of 48 months Model Design: Up to $30 million for up to 15 states ($1-$3 million per state) Model Test: Up to $700 million for up to 12 states ($20-$100 million per state based on state population and scope of proposal) 5 Reaching across Arizona to provide comprehensive quality health care for those in need

Proposed Arizona Strategy Arizona well-positioned to focused on driving innovation by expanding successful public private partnership Proposal would build on numerous existing initiatives to: o Reduce fragmentation o Integrate the delivery system o Align incentives to reduce costs and improve quality Align with (without duplicating) other efforts such as Medicare initiatives, where possible 6 Reaching across Arizona to provide comprehensive quality health care for those in need

Proposed Arizona Strategy (ctd.) Environmental scan of numerous value-based purchasing and reform efforts identified a need for support of behavioral health integration and efforts, including efforts to address substance use disorders o Gaps in existing efforts (e.g., ACOs) o Siloed public system o Lack of coordination among payers and providers (and infrastructure needs to enable coordination – data gaps) Without addressing behavioral health needs, numerous other reform efforts will face continued challenges. For example: Reducing ED use and readmissions Public health efforts to curb obesity, smoking, etc. Value-based purchasing 7 Reaching across Arizona to provide comprehensive quality health care for those in need

Proposed Arizona Strategy (ctd.) Focus Areas Integration and Coordination for AHCCCS members and Dual Eligibles Justice System Transitions SuperutilizersWorkforce Strategies QHP Coordination Alignment with Public Health Efforts American Indian Care Coordination Evaluation 8 Reaching across Arizona to provide comprehensive quality health care for those in need

Proposed Arizona Strategy (ctd.) Examples of Potential Funding Targets HIT for BH ProvidersBuild upon SHIP strategies Grants to major providers who partner with BH providers on integration and data sharing Evaluation of effective provider practices and clinical training for integrated delivery system. Funding for plans that partner with RBHAs on VBP Care Coordination Efforts between QHPs, AHCCCS plans, RBHAs, other? American Indian Care Coordination Infrastructure – sharing between key IHS, 638 and non-tribal providers Evaluation 9 Reaching across Arizona to provide comprehensive quality health care for those in need

Stakeholder Engagement Arizona strategy requires broad engagement and support from stakeholders o Kickoff meeting and letters of support for application by July 11 o Structured workgroups on initiative focus areas o Ongoing, collaborative participation in initiative 10 Reaching across Arizona to provide comprehensive quality health care for those in need

Next Steps Stakeholder letters due to Governor’s Office July 11, 2014 Arizona to submit Model Test application on July 21, 2014 Presentation to CMS/HHS experts in late summer/early fall Award in Fall 2014 Work continues 11 Reaching across Arizona to provide comprehensive quality health care for those in need

Questions? 12 Reaching across Arizona to provide comprehensive quality health care for those in need

Thank You. 13 Reaching across Arizona to provide comprehensive quality health care for those in need