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

National Academy for State Health Policy Annual Meeting

Kansas City, MO

October 4, 2011

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• Assist policymakers and safety net providers to plan for change-financial and organizational

• Conduct large scale strategic planning effort not otherwise possible

• Using national and state-level experts with academic assistance to evaluate the potential impacts of ACA on states

• Identify opportunities for integration and coordination in the health care delivery system.

Major Goals

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1. Medical

2. Preventive

3. Dental

4. Mental health

5. Pharmacy

Emphasis on primary care

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ACA creates changes and opportunities for safety net providers-currently uncertain environment

•Increasing public and private coverage •Funds for FQHCs•Establishment of ACOs•Funds for HIT, HIE, EHRs and meaningful use•Funds for prevention•Medical home development

Background

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Why Iowa:

1.Iowa Safety Net Network was established

– Legislatively mandated organization that already brought all safety net providers together into a loose confederation

– Made communication and collaboration much easier

2.IowaCare program for low income, uninsured adults

– Adults up to 200% FPL

– Provides experience with population that will be Medicaid eligible in 2014

Background

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• Determine the current funding, expenditures, and infrastructure of the health care safety net at the state level, using Iowa as an example.

• Evaluate the potential implications of PPACA on funding, expenditures and infrastructure of safety net-related activities at the state level.

• Develop strategies for improving integration and coordination of safety net providers and organizations within the health care delivery system using Iowa as a model for change.

Objectives

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• Provides a state-level demonstration, informed by experts on a key delivery system question

• Identifies implications of ACA on financing and operations of safety net providers

• Focuses attention on an issue often overlooked

• Develop recommendations for improving coordination and integration.

• Contributes to the knowledge of policymakers, providers and the public

Contributions

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1. Holding weekly steering committee meetings

2. Identifying background information: funding levels,

funding sources, characteristics and locations of

safety net providers in Iowa.

3. Updated organizational structure at state level to

reflect the Safety Net Network’s State Leadership

group and State Advisory Group.

4. Added representatives from Wellmark BC/BS (Tom

Newton), Iowa Health Systems (Sabra Rosener), and

Iowa State Board of Health to state advisory group.

5. Identified the National Advisory Committee members.

Progress to date

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6. Added Legislators to Advisory Group (Sen. Jack Hatch (D)

and Rep. Linda Miller (R)), and four consumer members

7. Held our first two State Leadership Group meetings

8. Collecting comments from all parties regarding the

positive and negative impacts of the ACA for their groups

and opportunities for coordination with the private sector

9. Held first State Advisory Group meeting

10. Created a Basecamp, project management site where all

participants will be able to obtain all background reports,

project timelines etc.

11. Holding first National Advisory Committee meeting

Progress to date

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Primary Care Safety Net Providers in Iowa

1.Federally Qualified Health Centers (FQHCs)

2.Rural Health Clinics (RHCs)

3.Free Clinics

4.Family Planning Clinics

5.Mental Health/Substance Abuse Treatment Centers

Background being collected-Providers

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Payers of Primary Care Safety Net Services in Iowa

1.Medicare

2.Medicaid

3.Children’s Health Insurance Program (CHIP)

4.Title V

5.Ryan White

Background being collected-Payers

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Basecamp

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Provider Concerns Benefits Opportunities

RHC Manpower shortageChanges necessary to take advantageSmaller clinics not prepared to take advantage

Reimbursed for servicesAccess to specialty care

Depends on RHC inclusionWork with local boardsRHC affiliate with private providers

HH Disincentive created – “cherry-picking”Cost to upgrade to e-chartingUndocumented individualsConcern about staff shortages

Transformation grantStreamlined accessAccess to affordable insurance easier – reducing safety net need

Patient information e-exchangePartnerships

Public Health

Certain groups and industries attempting to carve out their piece to remain viable as ACA develops

Remove fragmentation and streamlining will help make better use of public $$

Benefits of partnerships between private providers and state/federal public health programs

FQHCs Congress won’t support ACA Fewer uninsuredMore resources

Integration and coordination with private providers

Community Health

Unfamiliarity in navigating system (patients)Worker shortage (provider)Funding stream uncertainty (primary care)Disjointed funding stream (Care system)

Iowa as a leaderHealth improvements with basic primary careReimbursement for group previously uncovered

Developing capacityManaging chronic illness improvementsGreater patient empowerment

Provider Concerns, Benefits and Opportunities regarding ACA in Iowa

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1. Ability to integrate with ACOs

2. Ability to be part of products offered by health benefits exchanges

3. Impact on workforce shortages in primary care, behavioral health, etc. --more challenging for safety net providers to address

4. Patient-centered medical homes/community utilities/enabling services needed to help patients be successful.

5. Impact on social determinants of health for patients

6. Implications of barriers such a stigmas with government-funded program expansion

Additional Safety Net Questions

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Questions?