Public Health and the ACA

Iowa Department of Public Health

Office of Health Care Transformation

Angie Doyle ScarAbby Less

Iowa Initiatives

Community Care Coordination Project State Innovation Model Health Insurance Marketplace Iowa Heath and Wellness Plan Healthy Behaviors Program IDPH Affordable Care Act Impact Study

Community Care Coordination Project

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Purpose: Development and implementation of a statewide regionally based network to provide an integrated approach to health care delivery through care coordination that supports primary care providers and links patients with community resources necessary to empower patients in addressing biomedical and social determinants of health to improve health outcomes.

Community Care Coordination Teams

Accountable Care Organizations

ACO and Managed Health Care Definitions

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An accountable care organization (ACO) is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.

The term managed health care is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, for organizations that use those techniques or provide them as services to other organizations, or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts.

SIM Round One: Design Eight month design grant awarded February 2013 Submitted design in December 2013

o State Healthcare Innovation Plan (SHIP), o Five year visionary plan

19 required components, including:o Vision statement for system transformationo Well-defined “AS IS” and “TO BE” for transformed stateo Barriers and opportunities o Population health status, social/economic impacts on

healtho Timeline

Iowa’s SIM Website: http://www.ime.state.ia.us/state-innovation-models.html

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SIM Round Two: Test

On December 16, 2014 CMS announced o 11 Test states ($620m) includes Iowa! o 21 Design states ($43m)o Iowa received approval for $43.1m over 4yrso Funds released 1 year at a time

One pre-implementation year & three test yearso Each year the state requests a non-competing

extension to draw down more funds

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Recently Announced SIM Awards

Model Testing Proposal

Iowa must apply policy and regulatory levers to address three focus areas:

1. Transform health care delivery systems 2. Improve population health3. Decrease per capita total health care

spending

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Transform Health Care Delivery

Expand ACO Model to Full Medicaid

Expand PCP Assignment

Shared Savings with Risk

Incrementally add LTC/BH

Services

Care Coordination payments for

chronics (aligned with

HH)

Align with Other Payers

Use VIS

Develop VIS Star Rating

Include Medicaid HMO/CHIP

Plans

Support ACO Delivery System

Develop Community Care

Teams

Develop Admission Discharge

Transfer (ADT) system (HIT/IHIN)

Technical Assistance

approach with IDPH

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Improve Population Health

Improve Population Health/ Healthiest State Initiatives

Tobacco Use

Diabetes

Obesity/Childhood Obesity

Hospital Acquired Infections

Obstetrics Adverse Events

Engage Patients/Improve Health Literacy

Build from Healthy Behavior Program

Use HRA to measure Patient activation

Utilize Public Partnerships for

education & outreach

Measure Member Experience

Choosing Wisely Campaign

Collect Social Determinants of Health

Impact Individual

patient care

Implement Community SDH Transformation

grants

Study potential risk adjustment

on ACO payment model

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Decrease Per Capita Health Care Costs

Evaluation and Monitoring

Conduct Rapid Cycle Evaluations

Track Total Cost of Care

Public Reporting of

Results

Achieve Scale within an ACO model

Align and partner with Public Payers

(CHIP/M-HMO)

Align and partner with

Private Payers

Track VIS ImprovementMonitor VIS and TCOC

relationship

Identify sub populations needs

improvements

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Iowa’s Health Insurance Marketplace

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Iowa Enrollment: (November 15, 2014 – January 16, 2015)

36,718 Iowans selected a Marketplace plan 42% are new consumers 58% are consumers reenrolling in Marketplace coverage

30% are under age 34 57% selected a Silver Plan 86% received financial assistance

Source: http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Jan2015/ib_2015jan_enrollment.pdf

Iowa’s Navigators

Special Enrollment

May enroll or change Qualified Health Plan Within 60 days in individual market and 30 days in small group market from qualifying

event

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Special Enrollment Period Qualifying EventsLoss of minimum essentialcoverage

Material contract violations by Qualified Health Plans

Gaining or becoming adependent

Gaining or losing eligibility for premium tax credits or cost sharing reductions

Gaining lawful presence Relocation resulting in new or different Qualified Health Plan selection

Enrollment errors of the Marketplace Exceptional circumstances*

* May be granted on a case by case basis.

Where States Stand on Medicaid Expansion Decisions

*Map updated February 6, 2015

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Iowa Health and Wellness Plan

• Began January 1, 2014

• Iowans age 19 - 64

• Income up to and including 133% of the Federal Poverty Level (FPL)

• New, comprehensive program replaced the IowaCare program, which ended December 31, 2013

The Iowa Health and Wellness Plan was enacted to provide comprehensive health coverage for low-income adults

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Iowa Health and Wellness Plan Enrollment

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One Plan, Two Options

Iowa Wellness Plan• For adults age 19 - 64• Income up to and including 100% of the Federal Poverty Level

Iowa Marketplace Choice Plan• For adults age 19 - 64• Income 101% to no more than 133% of the Federal Poverty Level

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Iowa Wellness Plan: 0-100% FPL

Family of one

$11,670

Family of two

$15,730

Individuals up to

100% FPL

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Quick Facts• Administered by Iowa Medicaid

• Uses Iowa Medicaid provider network

• Offers comprehensive set of benefits

• Uses a primary care case management (PCCM) program, referred to as managed care

• Primary Care Patient Manager, or primary care provider (PCP) coordinates care and referrals for the member

Iowa Wellness Plan: 0-100% FPL

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Marketplace Choice Plan: 101-133% FPL

Family of one

$11,671-

$15,521

Family of two

$15,731-

$20,920

Individuals 101% FPL

up to133% FPL

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Healthy Behaviors and Monthly Contributions

• Iowa Wellness Plan Contribution: $5 per month

• Iowa Marketplace Choice Plan Contribution: $10 per month

• No copayments except for using the emergency room when it is not an emergency

• No monthly contributions during the first year (2014)

• No contributions for those with income below 50% FPL

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Healthy Behaviors and Monthly Contributions

Monthly contributions waived beginning in 2015 if the member completes wellness activities

First year members need to complete health risk assessment and wellness exam (annual physical)

Healthy Behaviors Completed in 2014

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o 28,841 Health Risks Assessmentso 30,546 Wellness Examso 15,626 members completed both

activities

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• Began May 1, 2014

• Adequate reimbursement rates for dental services

• Contracting with a commercial dental plan to cover services & Provider Network

• Population health approach

• Member incentives: providing basic services, with ability to earn higher cost restorative services

Dental Wellness Plan

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Medically Exempt

• Members who are considered ‘Medically Exempt’ must be given the option of enrolling in regular State Medicaid Plan or Wellness Plan

‘Medically Exempt’ includes individuals with disabling mental disorders (including adults with serious mental illness), individuals with chronic substance use disorders, individuals with serious and complex medical conditions, individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living, or individuals with a disability determination based on Social Security criteria

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Application Process

APPLICATION

PROCESS

DHS Contact Center

1-855-889-7985

Federal Health Insurance

Marketplacewww.HealthCare.go

v

DHS websitedhsservices.iowa.govDHS Local

Offices

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Iowa Health and Wellness Plan Information

Find up-to-date information onthe Iowa Health and Wellness Plan at:

http://www.ime.state.ia.us/iowa-health-and-wellness-plan.html

IDPH Affordable Care Act Impact Study

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The study focuses on three areas: covered populations, covered benefits, and provider networks. In summary, the final report projected the following:

Overall demand for IDPH-funded substance abuse treatment is projected to initially decrease and then remain level through 2017, with IDPH responsible for a reduced percentage of outpatient treatment services and all residential treatment.

Demand for home care aide and nursing services will not change, primarily because the covered population is generally aged 65 and older, and therefore not eligible for ACA enrollment.

Demand for tobacco Quitline and tobacco-related cessation services is projected to increase as such services are not currently available in some new health plans.

Demand for cervical cancer screening and other preventative services is projected to decrease as historically eligible women become enrolled in new health plans.

IDPH is now working with Milliman on a similar analysis of four more direct healthcare services programs: Chlamydia Testing and the Ryan White program, Oral Health Sealant Dental Services, Title V Maternal and Child Health, and Title X Family Planning.

Questions?

Contact Information:

Angie Doyle Scar- 515-954-9537 Angela.DoyleScar@idph.iowa.gov

Abby Less- 515-321-4361 Abby.less@idph.iowa.gov