Building an Integrated Health Care System
Today’s health care system is a series of parts not yet connected to each other. Improving care coordination and communication while reducing fragmentation weaves these series of parts together to create a more effective health care system. AHCCCS efforts to integrate care delivery systems and properly align incentives are designed to transform the structure of the Medicaid program to improve health outcomes and better manage limited resources.
The Department of Economic Security/Division of Developmental Disabilities (DES/DDD) provides health care to eligible DDD members through the Arizona Long Term Care System (ALTCS).
Starting October 1, 2019, behavioral health service responsibility for these enrolled members will transition from the Regional Behavioral Health Authorities (RBHAs) to integrated health plans contracted with DDD (DDD Health Plans). This transition will include members with a designation of Serious Mental Illness (SMI). These DDD Health Plans will also provide services for DDD members with qualifying Children’s Rehabilitative Services (CRS) conditions.
In Arizona, behavioral health is a carved out benefit separately managed by Regional Behavioral Health Authorities (RBHAs). As such, a person with a serious mental illness (SMI) could navigate up to four different health care systems to get care – their AHCCCS acute health plan for physical health services; the RBHA for their behavioral health services; Medicare, since many persons with SMI are dually eligible for Medicaid and Medicare; and Medicare Part D for medications. Navigating the health care system is one of the greatest barriers to accessing care. The result for Arizonans with SMI was less than optimal. Concerns around poor medication management and stigma caused many people to forgo physical health care. Because many persons with SMI also experience co-morbidities, management of chronic diseases like diabetes or hypertension was also poor. Learn more about what AHCCCS is doing to integrate care for individuals with SMI
Medicare and Medicaid Alignment for Dual Eligibles: Alignment Makes a Difference
Medicare presents one of the greatest challenges to states serving individuals dually eligible for Medicaid and Medicare. Medicare is its own distinct, complex system of care operated by the federal government with little to no interface with state Medicaid programs. For the over 150,000 Arizonans that are eligible for both Medicare and Medicaid, navigating these two separate systems of care can be overwhelming. Under these circumstances, people fall through the cracks, inefficient care is provided, and optimal health outcomes are not achieved. Learn more about what AHCCCS is doing to bring these two systems together on the Duals page.
Simplifying the System of Care for Children with Special Health Care Needs: Children’s Rehabilitative Services (CRS)
Children’s Rehabilitative Services (CRS) was started in 1929 to serve children with complex health care needs who require specialized services. Services for the treatment of CRS qualifying conditions were previously managed solely through the CRS program. Medicaid members would then have to access routine or other non-CRS specialty physical health care through their AHCCCS acute plan and behavioral health through the RBHA. For children that were Medicare eligible, the family had one additional hurdle. Arizona families attempting to care for their child with special health care needs was being asked to navigate up to four systems of care. Learn more about what AHCCCS is doing to bring these two systems together on the CRS page.
AHCCCS has partnered with state and county governments to improve coordination within the justice system and create more cost effective and efficient ways to transition people leaving the criminal justice system. A significant number of men, women and children transitioning out of jail and prison into communities are in need of services for behavioral health and physical health conditions. Many of these individuals are eligible for Medicaid.
To facilitate this transition, AHCCCS is engaged with the Arizona Department of Corrections (ADOC) and most Arizona counties covering the majority of the State’s population, including the two largest – Maricopa and Pima – in a data exchange process that allows AHCCCS to suspend eligibility upon incarceration, rather than terminate coverage. This exchange also allows ADOC and counties to electronically send discharge dates, which simplifies the process of transitioning directly into care. Through this enrollment suspension process, care can be coordinated by county jails or prisons upon discharge. To support this, all RBHAs are contractually required to have a justice systems contact that can ensure a connection to needed behavioral health services. In addition, AHCCCS medical management coordinates with counties to facilitate a transition to care into acute health plans for persons being discharged with serious physical illnesses, such as cancer or other illness, that present public health concerns or require immediate attention. More information will be posted soon.