Fireside Chat: Arizona’s Quality Pursuit

July 12, 2022 · Tom Curtis

Arizona is best known for the Grand Canyon, a deep gorge formed by the relentlessness of the Colorado River.  In health policy circles, however, Arizona is known for bold ideas and innovation.  Like the Colorado River and the sandstone walls of the Grand Canyon, the state’s Medicaid agency is a relentless force for change on behalf of the people it serves.  Whether it’s the integration of physical and behavioral health, population health management, or the incorporation of social service supports—Arizona Medicaid is an exemplar program for taking action and demonstrating impact.

Under Director Jami Snyder, Arizona Medicaid has continued to show positive financial and health improvements while focusing on whole-person care, data exchange and responsible management of the State’s $18 billion Medicaid program serving 2.3 million State residents.

Arizona Discovered Fireside

During our recent NCQA Fireside Chat series, NCQA’s President Peggy O’Kane hosted Director Snyder for a talk about the agency’s success and the director’s vision and strategies for whole-person care in Arizona Medicaid.  Peggy opened the  discussion by congratulating Arizona Medicaid leaders for their “relentless pursuit of integration, because we know it matters to the whole person.”

Director Snyder described Arizona Medicaid’s approach to financing and policy changes adopted to integrate whole-person care at the provider level.

“Those programs include the implementation of a closed-loop referral system…that makes it easier for clinicians…to connect [patients] to needed social services,” Snyder explained.  “We call that platform CommunityCares.”

However, Arizona’s relentless pursuit of whole-person care doesn’t stop at an IT platform.  Director Snyder’s team also works with CMS on what they call “Targeted Investments 2.0.

These include:

• Payments to providers for specific milestones such as referring to community-based organizations.
• incentives for training on Cultural and Linguistically Appropriate Services (CLAS) standards.
• implementation of trauma-informed care models.
• Connection to the State’s health information exchange.
• Use of the CommunityCares platform.

Renewed Role For Community

In addition to screening for social needs and encouraging providers to work with community organizations, Arizona Medicaid targets specific subpopulations in need of enhanced services and specific social issues that need enhanced investments.

“Your program understands population health as well as anybody,” said NCQA President Peggy O’Kane.

Arizona Medicaid recently implemented 13 Justice Clinic Sites, which integrate physical and behavioral healthcare, as well as parole and probation services—all in the same location.

“We [also] do a tremendous amount of work in the housing arena,” said Director Snyder.  “We have an expectation of our health plans that 6% of their profits are reinvested into the community…and our health plans have pooled a portion of that reinvestment funding to stand up a program called Home Matters to support the development of affordable housing throughout the State.”

And that’s not all.  The Arizona Medicaid program receives nearly $27 million in annual funding to provide rental subsidies to members along with wrap-around support services.  Data show a 31% reduction in Emergency Department (ED) utilization, a 44% reduction in inpatient admissions and savings of $5,500 per member per month for those housed for six months or more.  Arizona is currently in discussion with CMS to provide a Federal funding match to expand that benefit.

“Peggy, I think you captured it best at the beginning, you said we’re relentless.  I think you’re absolutely right…and I think we’re fearless,”  Snyder added. “I tell my team often don’t be afraid to fail.  That’s going to happen, but ultimately that’s what it’s going to take for us to succeed.”