AHCCCS Payment Modernization

Overview

Modernizing the way health care services are purchased means rethinking the end product. Today’s reimbursement structure favors the provider with higher production numbers, i.e. performs more services without regard to outcome. In order to bend the cost curve, there must be a paradigm shift such that reimbursement favors the provider who achieves a quality health outcome. That is why payment modernization is a critical policy strategy for moving to a financially sustainable and value-based healthcare delivery system.

To that end, AHCCCS is pursuing the implementation of long-term strategies that bend the cost curve while improving member health outcomes. The overall mission is to leverage the AHCCCS managed care model toward value based health care systems where patients’ experience and population health are improved, per-capita health care costs are limited to the rate of general inflation through aligned incentives with MCO and provider partners, and there is a commitment to continuous quality improvement and learning.

Strategies

Align Payer & Provider Incentives: Establish payment systems that encourage collaboration to improve affordability, access and quality results for individuals.

Payment and Care Delivery Transformation: Transform the health care delivery system and achieve the three-part aim outlined by the Institute of Medicine (IOM): better care, healthy people/healthy communities, and affordable care.

Innovate through Competition: Enact performance expectations that reward innovation and results.

Pay for Value: Pay for outcomes of care rather than quantity of care.

Collaborative Learning: AHCCCS is a committed partner in the Health Care Payment Learning and Action Network (LAN). The goal of the LAN is to accelerate the health care system’s adoption of effective alternative payment models (APMs). AHCCCS will work to continue to shift an increasing percentage of payments into Categories 3 and 4 value-based structures. The LAN also has compendium of APM resources for health care providers and payers.

Payment Modernization Initiatives

Payment Modernization Plan

The AHCCCS Payment Modernization Plan includes a discussion of the current healthcare delivery and payment system, the framework for moving payment modernization forward, and actions needed for successful system transformation.

Resources