Evaluation of Arizona's Health Care Cost Containment System demonstration : final report

179 Pages·1996·5.7 MB·English

by  McCall, Nelda

EVALUATION OFARIZONA'S HEALTH CARF rncr
CONTAINMENTSYSTEM DEMONSTRATION
FINALREPORT
February 1996
Preparedfor:
JoanPeterson
IHeJal-thX°03L™T.dTanHceian'tghARdem,ionrirsntrDaetmio°nnstrations
/bOOSecurityBoulevardC-3-18-26
Baltimore, MD21244-1850
Laguna Research Associates
455MARKETST,SUITE 1190,SANFRANCISCO.CA94,05 415-5l2-748o'

EVALUATION OFARIZONA'S HEALTH CARE COST
CONTAINMENT SYSTEM DEMONSTRATION
FINALREPORT
February 1996
Prepared for:
Jodn Peterson
OfficeofState Health Reform Demonstrations
Health Care FinancingAdministration
7500SecurityBoulevard C-3-18-26
Baltimore, MD21244-1850
Preparedby:
NeldaMcCall
C. William Wrightson
Jodi Korb
Michael Crane
William Weissert
John Wilkin
This reportis basedonworkfundedunderHCFA Contract Number
HCFA-500-89-0067to Laguna ResearchAssociates. The HCFA
projectofficersoverthedurationoftheevaluationwere Ronald
Lambert, James Hadley, andJoan Peterson. Theanalysisand
conclusionsaresolelythoseoftheauthorsanddo notexpressany
officialopinionoforendorsementbythe Health Care financing
Administration.

ACKNOWLEDGEMENTS
The authors would like to express their appreciation to the many people
over the course of the AHCCCS evaluation who have contributed to the project
either through their work on various aspects of the project or their comments
on drafts of final reports or articles. We are especially grateful for their
comments to those at the AHCCCS Administration as well as to Sidney Trieger,
Ronald Lambert, James Hadley, and Joan Peterson from the Office of Research
and Demonstrations at HCFA. Our collegues who have worked on the AHCCCS
evaluation all contributed to the thinking presented in this final report and
should be acknowledged directly: Donald Balaban, Ellen Jones Bauer, Suzanne
Pollack Driver, Susan Haber, Sande Kiriluk, Stanley Moore, Lynn Paringer,
Neil! Piland, Betty Skipper, Gordon Trapnell, Pamela Turner, Alice Wade, and
Margaret Watkins. We are also grateful to the following people for their
administrative, editorial and research support during the course of the
project: Kathleen Foley, Leslye Garrison, James Genuardi, Melissa Constable
Musliner, and Jon Tomlinson. A final thanks should be given to Steven Mangle
and Tara Washburn, who managed the production of this report.
i
I1
TABLE OF CONTENTS
GLOSSARY OF ABBREVIATIONS AND ACRONYMS v
I. INTRODUCTION 1
The AHCCCS Program 1
The Program Evaluation 15
II. THE IMPLEMENTATION & OPERATION ISSUES 21
Overview 21
Effectiveness of Program Contractors 21
Method of Setting Capitation Payments 36
Preadmission Screening, Level of Care Determination, and Use
of Home and Community-Based Services 51
Administrative Costs 68
Management Information System 80
III. THE OUTCOME ISSUES 93
Overview 93
Utilization of Services 94
Special Studies 110
Cost of the Program 120
IV. SUMMARY AND CONCLUSIONS 137
Implementation and Operation Findings 137
Outcome Findings 145
Conclusions 152
ENDNOTES 155
APPENDIX A A-l
APPENDIX B B-l
iii

GLOSSARY OF ABBREVIATIONS AND ACRONYMS
ABC Access Blue Connection
ADL Activity of Daily Living
AFDC Aid to Families with Dependent Children
AHC Arizona Health Concepts
AHCCCS Arizona Health Care Cost Containment System
ALTCS Arizona Long-Term Care System
APD Advance Planning Document
APIPA Arizona Physicians Independent Physicians' Association
AS AHCCCS Select
CATS Client Assessment and Tracking System
CCC Cigna Community Choice
CCDHS Cochise County Department of Health Services
CCIC Coordinated Community In-Home Care
CCP Children's Care Program
CMDP DES Comprehensive Medical and Dental Plan
CMP Children's Medical Program
CSDP Comprehensive Service Delivery Plan
DES Department of Economic Security
DHP Doctors' Health Plan
DSH Disproportionate Share Hospital
EAC Eligibility Assistance Children
ELIC Eligibility Low-Income Children
EPD Elderly and Physically Disabled
EPSDT Early and Periodic Screening, Diagnosis, and Treatment
FFS Fee-For-Service
FY Fiscal Year
HCA Health Choice of Arizona
HCB Home and Community-Based
HCBS Home and Community-Based Services
HCFA Health Care Financing Administration
HMO Health Maintenance Organization
IADL Instrumental Activity of Daily Living
ICF Intermediate Care Facility
ICF/MR Intermediate Care Facility for the Mentally Retarded
IHS Indian Health Service
LTC Long-Term Care
MCP Mercy Care Plan
MDS Minimum Data Set
MI Medically Indigent
MIS Management Information System
MN Medically Needy
MN/MI Medically Needy/Medically Indigent
MMCS Maricopa Managed Care System
MMIS Medicaid Management Information System
MR/DD Mentally Retarded/Developmentally Disabled
NCH National Claims History
NEAZ Family Health Plan of Northeastern Arizona
NHIS-SOA National Health Interview Survey - Supplement on Aging
NMAF New Mexico Abstraction Form
v
i
NNMNEHSS NNaattiioonnaall MNeudriscianlg HEoxmpeendSiutruvreey Survey
pppPACCHSLPSjC PPPPirrinemiaaamldamrHiyCesoasulCintaothrnyeSSLyPcsohrtnyeegsem-incTiienargnm Care
PQPPRHMMRAXBOMHIPS PPQPRhruerogeoaeipflonaeiniisfaxdsilieodHMneeAaadMHlliCetcCdhaCiRiScedavPrliHeaeMenwaanlBatOehgrnegemafPenilnicatnziaatrIiynofnormation System
Rcppvp RSteaqtueestFisfcoarlPrYoepaorsal
SShHmMoO Social Health Maintenance Organization
SSSSNNsOiFBpRA SSoSkiuixaptlpnhllieedmO-emnnNtiuabrlussinSg—BeucduFgr3aeic-tt-iyliR--teI-ycn--ocnomcmeiliation Act
TPL Third-Party Liability
VyrHjSLTC VYeanvatpaania HCeoaulntthy SLyosntge-mTserm Care
vi