Greetings again from sunny San Diego, where we are wrapping up The 2015 OPEN MINDS California Management Best Practices Institute – over the past few days we have had a great discussion of the policy and financing issues that are shaping the management landscape in the health and human service field.
One great session yesterday was about the emerging “integrated care” models in the Maricopa County system, presented by psychiatrist Don Fowls, M.D., who is working with Mercy Maricopa Integrated Care (Mercy Maricopa) – Integrated Care Management For The SMI Population: What The State of Arizona Can Teach California’s Medi-Cal System. It’s been over a year since we reported on the launch of the integrated care delivery framework for consumers with serious mental illnesses in Arizona (see Mercy Maricopa Integrated Care Launches Arizona Regional Behavioral Health Authority Contract).
Arizona’s Regional Behavioral Health Authority (RBHA) in Maricopa County, Arizona (GSA 6) currently serves 876,319 total Medicaid eligible members and is managed by Mercy Maricopa. Mercy Maricopa is a non-profit health plan sponsored by Mercy Care Plan and Maricopa Integrated Health System (MIHS). Mercy Care Plan is an Arizona Medicaid Plan sponsored by Dignity Health and Carondelet Health Network and managed by Aetna. MIHS is a county-wide public safety net health care system for Maricopa County residents. Mercy Maricopa is also administered by Aetna.
For its delivery system model, Mercy Maricopa Integrated Care (MMIC) is launching five integrated behavioral health and primary care options for consumer. The big change is not the models themselves but the plan for payment reform. Dr. Fowls noted, “We’re collaborating all the time and figure new things out, and big thing is payment reform. On the residential side, it’s fee-for-service (FFS), and on the outpatient it’s block funded. And while that has served a purpose, it’s now creating some really perverse incentives.”
- Person-Centered Medical Home Option – These are primary care focused with a coordinated care team. Currently they have 35,500 MCP members and 3,279 MMIC members. This model is financed with performance-based compensation.
- Person-Centered Health Care Home Option – This model, which focuses on providing services in one location using a single medical record, is for beneficiaries with the most complex behavioral and physical health needs. Mercy Maricopa care managers and care coordinators provide on-site enhanced care coordination for the clinics utilizing this model and are part of the existing clinical team workflows. The option provides fully integrated physical and behavioral health services. The care coordination in this model uses predictive modeling and other health information technology. This model uses a performance-based financing model.
- Assertive Community Treatment (ACT) – This model was described as a 24/7 health home without walls – or ACT team intensive. Each ACT team has 100 members, costing $1.6 million per team. This model is financed with performance-based capitation.
- Accountable Care Organizations (ACOs) – These are organized systems of health care provider organizations that include primary care, specialists and hospitals, with a shared accountability for the cost and quality of consumer care. One third of all MCP members and a quarter of all MMIC members are assigned to a PCP in an ACO. For example, Arizona Care Network (ACN) covers 49,179 MCP members and 4,479 MMIC members. This model is financed with a shared savings model.
- Federally Qualified Health Centers (FQHCs) – FQHCs are serving as integrated care delivery sites in the system. There are nine Maricopa County FQHCs covering 34,922 MCP members and 3,438 MMIC members, and their services will be financed with a shared savings model.
Dr. Fowls noted that Mercy Maricopa is pushing for having 50% or more of their total spend in value-based arrangement by 2017-2018. In addition to the value-based contracting for the primary locations of integrated care for consumers with SMI, there are three additional phases in the implementation process to come:
- Phase 1: Value-based contracts for permanent supportive housing and ACT along with scheduled implementation for Person Centered Healthcare Homes
- Phase 2: Clinically Integrated Organizations (CIOs) and Accountable Care Organizations (ACOs), providing comprehensive care (behavioral/physical) across the continuum of care
- Phase 3: Bundled payments/episodes of care for selected specialty conditions (obstetrics, pain management and orthopedics)
This concurrent evolution of integrated care coordination and pay-for-value is a scenario that I think we’ll see roll out across many health plans. The challenges for health plan and provider organization executives is in the design, the analytics, and the delivery system reengineering. Look for more coverage of this trend int he months ahead. For more, check out our Market Intelligence Report on health homes, How Are States Managing Medicaid Health Homes?: An OPEN MINDS Market Intelligence Report. To learn more about Arizona’s changing Medicaid system of care, the OPEN MINDS Arizona Behavioral Health System State Profile Report is now available for purchase in the OPEN MINDS e-store. And in the coming week we’ll continue our coverage from The 2015 OPEN MINDS California Management Best Practices Institute. And if you couldn’t join us this year, be sure to check out our coverage on Twitter @openmindscircle, with the hashtag #OMCalifornia.