Peter Damiano Director, Public Policy Center University of Iowa State Advisory Group Meeting

Peter DamianoDirector, Public Policy CenterUniversity of Iowa

State Advisory Group MeetingVia Webinar

June 19, 2013

Iowa Safety Net, the ACA and Related Primary Care Delivery System Changes:An Update

1. Completed Inventory reports2. Subcommittee activities3. Policy briefs underway4. Related projects

Health Benefits Exchange survey

Update: The Iowa Safety Net and ACA project

1. Steering Committee (10 members)2. Leadership Group (20 members)3. State Advisory Group (65 members)4. National Advisory Committee (8 members plus

CMWF staff)5. Subcommittees for:

• Safety net provider (FQHCs/Rural Health Clinics)

• Safety net payer (Medicaid)• Safety net primary care service area (Oral

Health)

Committee structures

Steering Committee: Meets Weekly

Pete Damiano-PI

Chris AtchisonChair, Safety Net Adv Council.

Ted BoesenIAPCA Exec Dir.

Keith MuellerUI CPH Professor

Sarah Dixon Gale, IAPCA

Suzanne BentlerPPC Res. Spec.

Michelle HolstIDPH

Jennifer SteenblockIDHS

Elizabeth MomanyPPC, Assoc. Res. Sci.

Marni BussellIDHS

State Advisory Group and Leadership groups meet quarterly

Virginia Tonelli, IAPCA

Deb Kazmerzak, IAPCA

National Advisory Committee

Catherine HessBarbara Wynn

Deborah Scott

Andrew Hyman Daniel Hawkins

William Finerfrock

Edward Schor

Leighton Ku

Completed Inventory Reports

1. Federally Qualified Health Centers (FQHCs)2. Rural Health Clinics (RHCs)3. Free Clinics4. Family Planning Clinics5. Community-based Adult Mental Health Centers

• Includes legal analysis of the ACA as it relates to each provider type

Completed Safety Net Provider Inventory Reports(financing, delivery system, clients)

1. Medicare2. Medicaid3. Children’s Health Insurance Program (CHIP)4. IowaCare5. Ryan White

Other Reports6. Public Health Block Grant and related services7. Uninsured in Iowa

Available at:http:ppc.uiowa.edu search: safety net study

Safety Net Payer Inventory Reports(financing, clients)

Subcommittee Activities

1. FQHC/RHC subcommittee– Safety net provider

2. Oral health subcommittee– SN primary care service

3. Medicaid subcommittee– SN payer

Subcommittee activities

• Primary goal: evaluate the capacity of the FQHCs and RHCs in Iowa and the barriers to expansion (facilities and workforce)

• Secondary goal: evaluate the current and future care coordination activities and whether they can function as part of a community utility model

FQHC/RHC Subcommittee

1. Established an FQHC/RHC subcommitteeo 2 meetings conducted

2. Developed capacity survey instrument to FQHCs/RHCs concerning:o Capacity for providing care currently,

o Barriers to growth,

o Interest in community utility-type functions

(More detail to follow)

FQHC/RHC Subcommittee

• Primary goal: evaluate the current access to and utilization of dental services and state of oral safety net (FQHCs and private practitioners)

• Secondary goal: Better understand the factors affecting dentists’ participation in Medicaid

• Additional support from the Dentaquest Foundation

Oral Health Subcommittee

1. Established a National Oral Health Advisory Committeeo 3 meetings conducted

2. Inventory report on oral health in Iowa (access, utilization health status)

o First draft complete and reviewed by NAC

3. Survey Iowa private dentists about Medicaid participation and attitudes (1400 private practice, all specialties)

o Data collected, being analyzed

o Draft Report July 2

4. Conjoint analysis survey (scenarios)-300 dentists agreed to participate

o E-mailed to dentists: August 1

Oral Health Subcommittee

Topics:1. Oral health delivery system2. Financing of oral health care3. Access and utilization of oral health services4. Oral health status of Iowans5. State oral health promotion/disease prevention programs

Data Sources:6. State and national health departments and agencies7. Non-profit think tanks (e.g., KFF, CDHP, Pew)8. Peer-reviewed journal articles9. Professional organizations (e.g., ADA, ADHA, ASTDD, NACCHO)

Oral Health Inventory Report

1. Current Medicaid participation

2. Attitudes towards Medicaid

3. Attitudes towards underserved populations

4. Attitudes towards CHCs

5. Attitudes towards corporate dental practices

6. Current practice patterns

7. Current and future use of Expanded Function Dental

Auxiliaries (EFDAs)

8. Use of health IT

Dentist Survey Domains

• Originally evaluating ability for Medicaid to absorb expansion

o Partially captured in the capacity survey with FQHCs/RHCs

• Now focusing on ACO, Community Care Team and health home development

o Participating in NASHP Medicaid TA projecto Community care team policy briefo Participation of safety net providers in ACOs for

policy brief

Medicaid subcommittee

Policy Briefs

1. Safety net provider revenue and potential impacts of ACA expansion on FQHCs

2. Capacity of FQHCs and RHCs to deal with new patients post ACA insurance expansion

3. Incorporating safety net providers into ACOs4. Care coordination/care management and the role for

the safety net

4 Policy Briefs In Progress

1. Financing of care for FQHCs, RHCs, Title X family planning clinics, free clinics and Community-based MH Centers in Iowao Including revenue sources, demographic

characteristics of populations2. Modeling of revenue for FQHCs based on

experience in Massachusettso Chose FQHCs because most data were available

and most experience known• Draft report to CMWF: July 5

Policy Brief 1: Safety Net Funding sources

Online survey with all FQHCs and RHCs in Iowa– 14 FQHCs– 138 RHCs

Questions by domain• Current Demand • Increase in Demand • Current Capacity • Increase in Capacity • PCMH• Org. Readiness for Change

Policy Brief 2: Capacity of FQHCs/RHCS

Survey currently in the fieldo survey e-mailed with hyperlink to 14 FQHCs, 138

RHCs in Iowa: June 10

o Data collection complete: July 5

o Draft brief to CMWF: August 30

• Site visits to be conducted in August 2013 with 3 FQHCs and 3 RHCs

• Will lead to policy briefs on ability of FQHCs and RHCs to accept new patients from ACA

Policy Brief 2: Capacity of FQHCs/RHCS

• Primary Research Question: – What are the opportunities and barriers for the

inclusion of safety net providers in ACOs that are developing in the state?

• Based on structured interviews with:– Health system leaders and providers– Public and and private payers/insurers

• Interviews began April 29

Policy Brief 3: Safety Net and ACOs

Have interviewed: – Mercy Des Moines– Wellmark– COOP– IME

To be interviewed:– Fort Dodge Pioneer ACO– UIHC/Mercy CR– Genesis– Mercy Mason City

Policy Brief 3: Safety Net and ACOs

1. Current care coordination activities being provided by FQHCs and RHCs

2. Interest in providing these in the future3. How to define these activities4. How they could integrate with ACOs to

provide more efficient care

Policy Brief 4: Care Coordination and the Safety Net

• Primary care providers

• Long-term care

• Public health departments

• Maternal/child health providers

• Area Agencies on Aging

• Family planning agencies

• Community action organizations

• Patient/family advocates

• Specialists/hospitals

• Legal aid services

• Organ associations

• Behavioral health providers

• Oral health providers

Partners in Community Utility

High-Level Primary Care Medical Home Functions 

Primary Care

Medical Home

Access & Continuity, Multi-Modal

Identify & Manage Patient

Populations

Plan & Manage

Care

Provide Self-Care & Community

Support

Track & Coordinate

Care

Measure & Improve

Performance

High-Level Regional Functions

Regional Entity

Accountability and Reporting

Medical Management

and Care Coordination

Primary Care Provider Support

Patient Engagement & Education

Outreach & Enrollment

Transportation Logistics

High-Level State Functions

State Level Entity

Data, Reporting,

Analytics, and Risk

Stratification

Evaluation of Regional

Entities and PCMHs

Social Determinants of

Health

Technical Assistance,

Best Practices, Network

Development

Pharmacy, Pain Management,

and Behavioral Health

Resources

Telehealth Infrastructure

Related project

• Consumer and business attitudes– Convenience sample with association members– Online and paper version

• Topics include:– Current coverage and importance of having/providing it– Knowledge and attitudes towards aspects of ACA– Where they get information about ACA and coverage– Importance of plans’ design such as provider panel– Need for help with online plan selection– How they get information about ACA and plans and what sources

do they trust the most

• Survey available at: http://iowahealthinsurancesurvey.com

Health Benefits Exchange Survey

• Participating organizations– Iowa Caregivers Assoc– IA Public Health Association– Chamber Alliance– Iowa Association of Business and Industry (ABI)– Professional Developers of Iowa (PDI)– AARP– FQHCs-select

• Respondents:– Over 500 completed so far– Most are consumers with employer-based insurance

Health Benefits Exchange Survey

Discussion

Vinny