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Jennifer Vermeer, Iowa Medicaid DirectorIowa Medicaid Enterprise
ObjectivesThe presentation will provide an overview of
Iowa’s strategy to strengthen, build upon, and align Federally Qualified Health Centers with IowaCare, an 1115 demonstration waiver, in order to create a health system better able to meet the state’s and national health care goals.
The presentation will include information about:IowaCareIowa’s FQHCsIowaCare Medical Home Model
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IowaCare HistoryIowaCare Act (House File 841) passed FY2005
IowaCare is a 1115 demonstration waiver
Goals of IowaCare are to:Expand access to health care coverage for low-
income, uninsured adults who are not eligible for Medicaid
Provide financial stability for safety net hospitals who have high amounts of uncompensated care
Experiment with health care innovations
IowaCare has provided necessary health care for over 72,000 Iowans from FY2005-2010.
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IowaCare MembersIowaCare covers single adults and
childless couples ages 19-64, up to 200% FPL, who do not qualify for Medicaid or other insurance
More than 80% of IowaCare members have income below 100%FLP
Members are required to pay a monthly sliding scale premium if above 150% FPL
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IowaCare Provider NetworkFrom SFY 2005 – 2010, the provider
network included:
University of Iowa Hospitals and Clinics (UIHC) Located in Iowa City (serves population Statewide)
Broadlawns Medical Center Located in Des Moines (serves Polk County
residents only)
39,000 enrolled as of August 2010
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IowaCare ServicesIowaCare services include:
Inpatient and outpatient hospital servicesPhysician and advanced registered nurse
practitioner services, including annual preventive physicals
Limited dental servicesSmoking cessation
IowaCare providers donate prescription drugs and some durable medical and equipment with their own funds.
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ProblemsAccess - Long travel distance to access care at UIHCHigh incidence of unmanaged chronic disease
25% have never had health insurance; 66% have not had insurance for more than 2 years
80% of patients have one or more chronic conditions (diabetes, chest pain, coronary artery disease, cancer, high blood pressure, pain)
IowaCare patients self report poorer health status than the general Medicaid population
Long wait times to access physician services at UIHC due to lack of reimbursement for UIHC physician services
Unreimbursed emergency care at non-IowaCare hospitalsUnmet needs due to program/funding limitations – i.e. no
mental health, no drugs, no podiatry, etc.
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IowaCare Expansion GoalsImprove geographic access of IowaCare
members to quality healthcareReduce duplication of servicesEnhance communication among providers/family
and community partners Improve the quality of healthcare to IowaCare
members through the patient-centered medical home model.
Promote and support a plan for meaningful use of health information exchange (HIE) in accordance with the Federal Register requirement
Expansion enacted in SF 2356 to begin in 2010.
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Expansion Specifics (SF 2356)Local Access:
Adds 13 FQHCs to IowaCare provider network Primary care services expansion will be phased in through
the network of Federally Qualified Health Centers in IowaSioux City and Waterloo first two sites for expansion, October
1, 2010Improved access to UIHC:
Adds partial reimbursement for UIHC physicians to reduce wait times for appointments
Medical home model to improve care delivery for chronic disease
Capped $2M reimbursement for emergency services at non-IowaCare hospitals (associated with inpatient stay)
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IowaCare Phase OutProgram will transition to Medicaid
Expansion under the Affordable Care Act January 1, 2014 when Medicaid will cover all persons 133% FPL and belowVast majority of the IowaCare population is
below 100% of FPL
The expansion of IowaCare serves as transition period and an opportunity to pilot the medical home model in Medicaid with the goal of replication.
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Why Expand IowaCare in FQHCs?Presence in and knowledge of their communities Experience working with current member and potential
new member population – mission to serve this population and willingness to provide subsidies, i.e. prescription drugs
Provide comprehensive primary care services (medical, oral, and behavioral health) as required by federal grant
Provide high quality of care made evident through national performance and outcome reporting requirements
Implemented a Population Patient Health Management System/Registry in 2007
Implementing a comprehensive electronic medical record
Progressing towards becoming a patient-centered medical home
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Iowa’s 14 FQHCs
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IowaCare Medical HomeSF2356 mandates that providers in the network
(UIHC, Broadlawns, FQHCs) comply with certification requirements of a Medical HomeMust meet equivalent of NCQA Level 1 certification by
the end of the year (September 30, 2011)Providers complete self-assessment toolTransition to state designated certification process
when available
IME specified minimum standards include:Provide Provider Directed Care Coordination ServicesDesignate a Care Management/Care Coordination staff
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IowaCare Medical Home, cont.Implement a Disease Management Program
Diabetes Disease Management is required during the first year. Subsequent studies will be added based on disease burden.
Implement a Wellness/Disease Prevention Program with quarterly reporting on quantities and activities
Demonstrate evidence of acquisition, installation and adoption of an electronic health record (EHR) system
Establish a plan for meaningful use of health information exchange (HIE) in accordance with the Federal Register requirement
Electronic system must include a Registry Function/Immunization Registry
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IowaCare Medical Home Payment System Methodology
Level of Certification/Ye
ar
Monthly Care Coordination
PMPM
Performance Based
Reimbursement
Possible Total Reimbursement
PMPMYear 1 $3.00 $1.00 $4.00
Year 2 Level 1 $1.50 $1.50 $3.00
Level 2 $2.50 $1.50 $4.00
Level 3 $3.50 $1.50 $5.00
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Selection of Performance MeasuresAll of the IowaCare providers will qualify for
HITECH Medicaid EHR incentive paymentsSelected measures that align with coming
meaningful use standardsSelected measures that are used by largest
commercial payor in their quality measurement program to align data collection for the provider
Combination of measures than can be collected from claims data and clinical measures providers will need to collect from their EHR
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IowaCare Medical Home Designations
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Medical Home CoverageCurrent IowaCare enrollment is approximately
38,000 adultsFirst phase of Medical Home will have 4 sitesOver half of enrolled (23,456) will be in medical
home as of October 1, 2010:11,740 – Broadlawns7,740 – UIHC533 – Siouxland FQHC (Sioux City, NW Iowa)3,476 – Waterloo FQHC (Northeast/North Central Iowa)
We expect enrollment to grow significantly in the regions of the state where FQHCs are added
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Phase-in ScheduleFY2011
October 1, 2010: Sioux City, Siouxland Community Health Clinic; Waterloo, Peoples Community Health Clinic
January 1, 2011: Fort Dodge, Fort Dodge CHC; Ottumwa, River Hills CHC May 1, 2011: Council Bluffs, Council Bluffs CHC; Storm Lake, United CHC
FY 2012 – Dates not specified Phase 1: Burlington, Southern Iowa CHC; Primary Health Care, Inc. (for
outside Polk County only) Phase 2: Dubuque, Crescent CHC; Marshalltown, Primary Health Care,
Inc. Phase 3: Davenport, Community Health Care; Cedar Rapids, Linn
Community Care
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Medical Home RequirementsMembers will be assigned to the Medical
Home based on county of residence
Members will have to access care through their medical home – referral required to access UIHC specialists
Prescription drugs will be covered by the Medical Home – through their own funds, so provider sets requirements
All of the providers have 340B drug programs
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Integration with UIHCFQHCs do not have specialty or hospital care
– that care still provided by UIHC
Model is to deliver as much care as possible in local setting (Medical Home) to avoid travel to UIHC
New role for UIHC and the other providers – need to create a network
Necessary for close coordination between medical home and UIHC specialists/hospital
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Strategies Strategies to support coordination (in addition
to care coordination):Electronic exchange of information between
IowaCare providers – test case for HIE development
Specialist support of primary care provider - Reimbursement for peer to peer consultation (to encourage collaboration among UIHC and medical home
Future – telemedicineEstablished referral protocols between providers
to reduce duplication of testing and evaluation, streamline process for members
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Questions?
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