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Iowa Safety Net and ACA Integration Project

A project focusing on integrating Iowa's safety net providers with ACA changes. Evaluate impacts, develop strategies, & improve coordination for health care delivery system changes.

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Iowa Safety Net and ACA Integration Project

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  1. 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

  2. Major Goals • 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.

  3. Emphasis on primary care • Medical • Preventive • Dental • Mental health • Pharmacy

  4. Background 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

  5. Background Why Iowa: • 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 • IowaCare program for low income, uninsured adults • Adults up to 200% FPL • Provides experience with population that will be Medicaid eligible in 2014

  6. Objectives • 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.

  7. Contributions • 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

  8. Progress to date • Holding weekly steering committee meetings • Identifying background information: funding levels, funding sources, characteristics and locations of safety net providers in Iowa. • Updated organizational structure at state level to reflect the Safety Net Network’s State Leadership group and State Advisory Group. • Added representatives from Wellmark BC/BS (Tom Newton), Iowa Health Systems (Sabra Rosener), and Iowa State Board of Health to state advisory group. • Identified the National Advisory Committee members.

  9. Progress to date • Added Legislators to Advisory Group (Sen. Jack Hatch (D) and Rep. Linda Miller (R)), and four consumer members • Held our first two State Leadership Group meetings • 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 • Held first State Advisory Group meeting • Created a Basecamp, project management site where all participants will be able to obtain all background reports, project timelines etc. • Holding first National Advisory Committee meeting

  10. Background being collected-Providers Primary Care Safety Net Providers in Iowa • Federally Qualified Health Centers (FQHCs) • Rural Health Clinics (RHCs) • Free Clinics • Family Planning Clinics • Mental Health/Substance Abuse Treatment Centers

  11. Background being collected-Payers Payers of Primary Care Safety Net Services in Iowa • Medicare • Medicaid • Children’s Health Insurance Program (CHIP) • Title V • Ryan White

  12. Basecamp

  13. Provider Concerns, Benefits and Opportunities regarding ACA in Iowa

  14. Additional Safety Net Questions • Ability to integrate with ACOs • Ability to be part of products offered by health benefits exchanges • Impact on workforce shortages in primary care, behavioral health, etc. --more challenging for safety net providers to address • Patient-centered medical homes/community utilities/enabling services needed to help patients be successful. • Impact on social determinants of health for patients • Implications of barriers such a stigmas with government-funded program expansion

  15. Questions?

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