Monday, November 11, 2013

Arizona Shows D.C. How it's Done: A tale of two rollouts

On October 1, two healthcare programs opened for enrollment in Arizona. The first was the federal health insurance marketplace; the second was the recently restored state Medicaid program, Arizona’s Health Care Cost Containment System (AHCCCS).

Since its creation in 1982, AHCCCS has been the gold-standard for cost-effective managed care in the country. AHCCCS is currently the 9th lowest-cost Medicaid program in the country, boasting costs of about$700 less per enrollee than the national average. The managed care model AHCCCS employs is based on competition, patient choice and appropriate medical management. The program has extremely low processing and eligibility error rates (1.1%compared to a national average of 6.7%) and has been recognized as utilizing “best practices” in cost avoidance and payment recovery activities.

AHCCCS has continuedthis reputation for quality service throughout the enrollment period following Gov. Brewer and the state Legislature’s expansion of eligibility and restoration of coverage for childless adults. Since the new eligibility requirements kicked in on October 1, AHCCCS, under the direction of Tom Betlach, has successfully enrolled thousands of Arizona’s uninsured, working poor. No serious glitches, no excuses, just real coverage in real time.

Contrast this with the rollout of the federal health insurance marketplace. Plagued by fundamental flaws in the website’s infrastructure, the online marketplace has thus far failed to provide the easy-access, affordable coverage the Administration promised. Serious concerns about the privacy of the data that consumers provide to the insurance exchange have further slowed its efficacy.

While the development of the federal health insurance marketplace is far more complex than the enrollment of Arizona’s restored AHCCCS population, the tale of these two health insurance rollouts is significant. Arizonans are fortunate to have a Medicaid program run on the principles of patient choice and efficiency, and the relative effectiveness of these programs over the last month only further highlights the stellar job that the AHCCCS team has done navigating the difficult issue of providing access to healthcare for our state’s working poor. 

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