AUGUST 6, 2012 VOLUME 19 NUMBER 30
The Director of Arizona's Medicaid program (AHCCCS - the Arizona Health Care Cost Containment System) testified last month before the United States Senate Special Committee on Aging, and his remarks caught our attention. Director Thomas Betlach was testifying about "dual eligibles" -- people who are eligible for both Medicaid (AHCCCS) and Medicare. He particularly was talking about Arizona's unusual approach, which utilizes managed care programs as the centerpiece for Medicaid recipients.
Mr. Betlach's testimony is interesting, at least to people with a strong policy bent. You can read his remarks online and decide if that includes you. But we were not as focused on dual eligibles and managed care as we were on his description about the Arizona program as it actually operates.
For instance, Mr. Betlach reported that 72% of Arizona's elderly and physically disabled (his term) Medicaid recipients are now receiving their care at home or in a community-based care setting -- as distinguished from institutionalization in a nursing home or similar facility. For Medicaid recipients with a developmental disability, that figure increases to 98% -- in other words, only two percent of Arizona's Medicaid-subsidized patients with developmental disabilities are in long-term care institutional settings.
Whatever you may think about Arizona's history of care for vulnerable patients (and we are not always big fans), that is pretty remarkable. Of course a significant percentage are receiving their care in assisted living facilities or adult care homes -- not nursing homes, but not exactly home, either. Mr. Betlach's testimony did not segregate out the numbers or percentages for those populations, but we are still impressed with the high percentage being cared for in settings other than nursing homes.
Another interesting element of Mr. Betlach's testimony: the managed-care emphasis in Arizona's AHCCCS program has helped increase the percentage of managed-care patients in Medicare, and has held down the costs of (among other things) prescription drugs and the long-term care costs themselves. And the savings at least arguably demonstrate better care: Arizona's Medicare/Medicaid patients have a one-third lower hospitalization rate and a 21% lower readmission rate after release from hospitalization.
Want to know more about AHCCCS, the Arizona Long Term Care System (ALTCS) and Home and Community Based Services (HCBS)? You might want to look at the AHCCCS reports page. From there you can link to reports prepared for the federal government, for the state legislature and other reports. One we found particularly interesting: a report to the federal government on HCBS care (the latest year available is calendar year 2010).
Haven't yet satisfied your inner wonk? Try the population statistics maintained by AHCCCS on its members and trends. Our favorite: we did not realize that the number of AHCCCS/ALTCS patients with developmental disabilities (24,654) was so close to the number of members listed as "elderly" or "physically disabled" (27,941). The former category seems to be growing ever-so-slightly faster than the latter, and that surprised us as well.