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Iowa Safety Net, the ACA and Related Primary Care Delivery System Changes: An Update. Peter Damiano Director, Public Policy Center University of Iowa State Advisory Group Meeting Via Webinar June 19, 2013. Update: The Iowa Safety Net and ACA project. Completed Inventory reports

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

An Update

Peter Damiano

Director, Public Policy Center

University of Iowa

State Advisory Group Meeting

Via Webinar

June 19, 2013

update the iowa safety net and aca project
Update: The Iowa Safety Net and ACA project
  • Completed Inventory reports
  • Subcommittee activities
  • Policy briefs underway
  • Related projects

Health Benefits Exchange survey

committee structures
Committee structures
  • Steering Committee (10 members)
  • Leadership Group (20 members)
  • State Advisory Group (65 members)
  • National Advisory Committee (8 members plus CMWF staff)
  • Subcommittees for:
    • Safety net provider (FQHCs/Rural Health Clinics)
    • Safety net payer (Medicaid)
    • Safety net primary care service area (Oral Health)
steering committee m eets weekly

Steering Committee: Meets Weekly

Ted Boesen

IAPCA Exec Dir.

Jennifer Steenblock


Pete Damiano-PI

Chris AtchisonChair, Safety Net

Adv Council.

Marni BussellIDHS

Virginia Tonelli, IAPCA

Sarah Dixon Gale, IAPCA

Suzanne BentlerPPC Res. Spec.

Elizabeth MomanyPPC, Assoc. Res. Sci.

Deb Kazmerzak, IAPCA

Michelle Holst


Keith Mueller

UI CPH Professor

State Advisory Group and Leadership

groups meet quarterly

national advisory committee

National Advisory Committee

Barbara Wynn

Leighton Ku

Catherine Hess

Deborah Scott

Andrew Hyman

Daniel Hawkins

Edward Schor

William Finerfrock

completed safety net provider inventory reports financing delivery system clients
Completed Safety Net Provider Inventory Reports(financing, delivery system, clients)
  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)
  • Free Clinics
  • Family Planning Clinics
  • Community-based Adult Mental Health Centers
  • Includes legal analysis of the ACA as it relates to each provider type
safety net payer inventory reports financing clients
Safety Net Payer Inventory Reports(financing, clients)
  • Medicare
  • Medicaid
  • Children’s Health Insurance Program (CHIP)
  • IowaCare
  • Ryan White

Other Reports

  • Public Health Block Grant and related services
  • Uninsured in Iowa

Available at: search: safety net study

subcommittee activities1
Subcommittee activities
  • FQHC/RHC subcommittee
    • Safety net provider
  • Oral health subcommittee
    • SN primary care service
  • Medicaid subcommittee
    • SN payer
fqhc rhc subcommittee
FQHC/RHC Subcommittee
  • 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 subcommittee1
FQHC/RHC Subcommittee
  • Established an FQHC/RHC subcommittee
      • 2 meetings conducted
  • Developed capacity survey instrument to FQHCs/RHCs concerning:
    • Capacity for providing care currently,
    • Barriers to growth,
    • Interest in community utility-type functions

(More detail to follow)

oral health subcommittee
Oral Health 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 subcommittee1
Oral Health Subcommittee
  • Established a National Oral Health Advisory Committee
      • 3 meetings conducted
  • Inventory report on oral health in Iowa (access, utilization health status)
      • First draft complete and reviewed by NAC
  • Survey Iowa private dentists about Medicaid participation and attitudes (1400 private practice, all specialties)
      • Data collected, being analyzed
      • Draft Report July 2
  • Conjoint analysis survey (scenarios)-300 dentists agreed to participate
      • E-mailed to dentists: August 1
oral health inventory report
Oral Health Inventory Report


  • Oral health delivery system
  • Financing of oral health care
  • Access and utilization of oral health services
  • Oral health status of Iowans
  • State oral health promotion/disease prevention programs

Data Sources:

  • State and national health departments and agencies
  • Non-profit think tanks (e.g., KFF, CDHP, Pew)
  • Peer-reviewed journal articles
  • Professional organizations (e.g., ADA, ADHA, ASTDD, NACCHO)
dentist survey domains
Dentist Survey Domains
  • Current Medicaid participation
  • Attitudes towards Medicaid
  • Attitudes towards underserved populations
  • Attitudes towards CHCs
  • Attitudes towards corporate dental practices
  • Current practice patterns
  • Current and future use of Expanded Function Dental Auxiliaries (EFDAs)
  • Use of health IT
medicaid subcommittee
Medicaid subcommittee
  • Originally evaluating ability for Medicaid to absorb expansion
      • Partially captured in the capacity survey with FQHCs/RHCs
  • Now focusing on ACO, Community Care Team and health home development
      • Participating in NASHP Medicaid TA project
      • Community care team policy brief
      • Participation of safety net providers in ACOs for policy brief
4 policy briefs in progress
4 Policy Briefs In Progress
  • Safety net provider revenue and potential impacts of ACA expansion on FQHCs
  • Capacity of FQHCs and RHCs to deal with new patients post ACA insurance expansion
  • Incorporating safety net providers into ACOs
  • Care coordination/care management and the role for the safety net
policy brief 1 safety net funding sources
Policy Brief 1: Safety Net Funding sources
  • Financing of care for FQHCs, RHCs, Title X family planning clinics, free clinics and Community-based MH Centers in Iowa
      • Including revenue sources, demographic characteristics of populations
  • Modeling of revenue for FQHCs based on experience in Massachusetts
      • Chose FQHCs because most data were available and most experience known
  • Draft report to CMWF: July 5
policy brief 2 capacity of fqhcs rhcs
Policy Brief 2: Capacity of FQHCs/RHCS

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 rhcs1
Policy Brief 2: Capacity of FQHCs/RHCS

Survey currently in the field

      • survey e-mailed with hyperlink to 14 FQHCs, 138 RHCs in Iowa: June 10
      • Data collection complete: July 5
      • 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 3 safety net and acos
Policy Brief 3: Safety Net and ACOs
  • 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 acos1
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 4 care coordination and the safety net
Policy Brief 4: Care Coordination and the Safety Net
  • Current care coordination activities being provided by FQHCs and RHCs
  • Interest in providing these in the future
  • How to define these activities
  • How they could integrate with ACOs to provide more efficient care
partners in community utility
Partners in Community Utility
  • 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
health benefits exchange survey
Health Benefits Exchange Survey
  • 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:
health benefits exchange survey1
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