Arizona SIM Strategy. SIM Overview CMS established State Innovation Model (SIM) Initiative for...

Arizona SIM Strategy

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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 healtho Transform delivery systemo Lower costs

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

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SIM Overview – Delivery System Reform• CMS has identified goals for delivery system transformation –

states must work toward engaging providers in:


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

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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


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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)


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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 fragmentationo Integrate the delivery systemo Align incentives to reduce costs and improve

quality

• Align with (without duplicating) other efforts such as Medicare initiatives, where possible


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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 disorderso Gaps in existing efforts (e.g., ACOs)o Siloed public systemo 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


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Proposed Arizona Strategy (ctd.)

Focus Areas

Integration and Coordination for AHCCCS members and Dual

EligiblesJustice System Transitions

Superutilizers Workforce Strategies

QHP Coordination Alignment with Public Health Efforts

American Indian Care Coordination Evaluation


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Proposed Arizona Strategy (ctd.)

Examples of Potential Funding Targets

HIT for BH Providers Build 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 providersEvaluation


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Stakeholder Engagement• Arizona strategy requires broad

engagement and support from stakeholderso Kickoff meeting and letters of support for

application by July 11o Structured workgroups on initiative focus

areaso Ongoing, collaborative participation in

initiative


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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


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Questions?


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Thank You.


Arizona SIM Strategy. SIM Overview CMS established State Innovation Model (SIM) Initiative for...

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