Iowa Collaborative Safety Net Provide Network
LEADERSHIP GROUP MEETING
AUGUST 6TH, 2013
AGENDA
12:00 PM-12:10 PM
Welcome and Introductions
Network Staff
12:10 PM-12:40 PM
Funding Recommendations for SFY14
Network Staff
12:40 PM-12:55 PM
Commonwealth Fund Project Update
Dr. Pete Damiano
12:55 PM-1:15 PM
Community Care Coordination Project Update
Sarah Dixon Gale
1:15 PM-1:40 PM
Safety Net Care Coordination Entity
Sarah Dixon Gale
1:40 PM-1:45 PM
Rural Health Clinic Practice Transformation Learning Collaborative
Network Staff
1:45 PM-1:50 PM
Outreach and Enrollment Strategy
Network Staff
1:50 PM-2:00 PM
Other Items, Next Steps, and Adjourn
SFY14 BUDGET
SFY13
SFY14 Request
SFY14 Actual
Provider Awards
Rural Health Clinics
Family Planning Agencies
Free Clinics
Federally Qualified Health Centers
$141,544
$0
$273,322
$75,000
$142,192
$100,000
$400,000
$75,000
$141,544
$0
$348,322
$75,000
Pharmaceutical Initiative
Iowa Prescription Drug Corporation
$318,415
$415,000
$413,415
Specialty Care Grants
$308,474
$450,000
$378,474
Board of Health Medical Home
Grants
$77,153
$77,609
$77,153
Maternal/Child Health Medical
Home Grants
$95,126
$95,582
$95,126
$145,785
$146,563
$145,785
$50,000
$50,000
$50,000
$1,484,819
$1,951,946
$1,724,819
Network Management
Sexual Assault Response Teams
TOTAL
SFY14 FUNDING RECOMMENDATIONS
Rural Health Clinics
 Free Clinics
 Federally Qualified Health Centers
 SART Initiative
 Pharmacy Initiative
 Medical Home
 Specialty Care

RURAL HEALTH CLINICS
Amount Available $141,544
Recommendation:

IARHC Support
RHC Provider Awards
$ 5,176
$136,368
Eligibility for RHC Provider Awards
FREE CLINICS
Amount Available $348,322
Recommendation:


FC Provider Awards
Free Clinics of Iowa
$125,000
$223,322
Line item increase for SFY14 of $75,000
FCI allocation would be used for state-wide support
including enhancing education and access of
patients from free clinics toward the Iowa Health
and Wellness Plan.
FQHCS
FQHCs
Amount Available
Recommendations
Funding be allocated evenly
to the state’s 14 FQHCs to
support statewide reform
initiatives
$75,000
SART INITIATIVE
Iowa Coalition Against Sexual Assault
Amount Available
$50,000
Recommendations
Fund
Reviewer Comments
•What is the retention rate of SANEs?
•Would like to see a map of SANE coverage in
the state
PHARMACY INITIATIVE
Iowa Prescription Drug
Corporation
Amount Available
$413,425
Recommendations
Fund
Reviewer Comments
•This project is dependent on state funding. Suggest
a sustainability plan
•The work plan could have included more concrete
dates
•Lack of diversified funding streams
•How many Pharmacists?
•How will the ACA affect the demand for these
services?
•Would be good to explore partnerships with the
Integrated Health Home
•Great work
MEDICAL HOME INITIATIVE
Local Boards of
Health
Amount Available
$77,153
Comments/Questions
Warren County
Fund : $25,717
• Lacking Oral Health
•Visionary, less concrete
•Feels like health promotion
than medical home
Cerro Gordo County
Fund : $25,717
•No reference to oral health
• How will medical home be
supported?
•Low number of patients served
•Connect with the United Way to
enhance efforts for both entities
Plymouth County
Fund : $25,717
• Developing a registry-population
management system
•Suggest they consider Mercy
Health Coach training
•Lacking oral health component
•Intended outcomes need clarity
MEDICAL HOME INITIATIVE
Maternal Child Health
Amount Available: $95,126
Questions/Comments
Webster County
Fund: $31,708
•Lacking oral health component
•Suggest incentive for patients in the
Better Choices program
•Deliverable #4 needs clarity
•Progressive, innovative community
•How will this spread to other
counties
Clayton County
Fund: $31,708
Iowa County
Fund: $31,708
•Kids and families were not a very
prominent part of the proposal
•Do providers include dentist?
•Strong partnerships, strong agency;
•Exploring ACOs
•Included dental component
•Great abstract
•A sealant program is not a dental home
•What are the gaps in the obesity issues
SPECIALTY CARE INITIATIVE
Specialty Care
$378,474
Applicant
Blank Children’s
Hospital
Crawford County
Memorial Hospital
Amount
Requested
$3,000
Medications
for free
clinic
patients
$154,828
Bilingual
health coach;
Hispanic
patients
Recommendation
Questions/Comments
Fund: No
•Should partner with IPDC
•Didn't follow the format.
•Might be able to apply to ECI
to support work
•Not a specialty care initiative
Fund: Yes
($49,802)
•Clinical Outcome measures
are ambitious but not
achievable;
•Should address impact of
Health Care Reform
•Need to revise work plan
SPECIALTY CARE INITIATIVE
Specialty Care
$378,474
Applicant
Polk County VPN
Amount
Requested
$237,960
Continued
funding
and
program
expansion
Recommendation
Fund: Yes
(213,748)
Questions/Comments
•Need more detail in
numbers served
•Budget is staff heavy;
suggest focus on
sustainability
•More information about
how referrals are tracked
SPECIALTY
CARE
INITIATIVE
Specialty Care
$378,474
Applicant
Primary Health
Care
Amount
Requested
$135,660
Recommendation
Fund: Yes
($114,924)
Expansion of
integrated
behavioral health
program to 2
additional sites
Linn County
Project Access
$69,500
Project Access
expansion
Fund: No
Questions/Comments
•Good job diversifying
funding
•Could be a statewide
model
•Very well leveraged;
expanding
•Ahead of the game
•Abstract or narrative
was missing.
•Work plan dates were
all past
•How is data tracked?
•Many of these services
will be covered under
the ACA
SPECIALTY CARE SUMMARY
SFY13
SFY14
Request
3,000
Recommendation
Blank Children’s Hospital Free Clinic
$
0
$
$
0
Crawford County Memorial Hospital
$
0
$154,828
$ 49,802
Polk County Medical Society VPN
$153,748
$237,960
$213,748
Linn County Project Access
$ 39,802
$ 69,500
$
Primary Health Care
$114,924
$135,660
$114,924
Total $308,474
$600,948
$378,474
0
Health Benefits Marketplace
Perceptions of Consumers in Iowa
Pete Damiano
Suzanne Bentler
Dan Shane
Iowa Safety Net Network Leadership Group Meeting
August 6, 2013
In this presentation
• Consumer survey
– Methods
– Demographics
– Insurance coverage and factors affecting choice
– Knowledge and Attitudes toward the ACA
– Marketplace preferences and assistance
Methods-Consumers
• Mixed mode (On-line and written in person)
• Convenience sample:
–
–
–
–
–
–
IA Caregivers Assoc. (both)
one Iowa FQHC (written)
Iowa State Extension (written)
IA Public Health Association (online)
AARP (online)
IDPH partners and local agencies
• 85 questions maximum
– 43 questions with some tables of multiple subquestions
• 498 responses so far
– 367 On-line
– 131 Written
Insurance Coverage Types
• Employer-based (<HBMP)-80% (n=396)
• Non-employer-based (>HBMP)-20% (n=102)
– Uninsured now or in last 12 months (5%; n=24)
– Self insured (5%; n=25)
– Public (10%; n=53)
•
•
•
•
•
Medicaid
IowaCare
CHAMPUS
VA
Military
*Medicare was excluded
Type of Assistance
• Who helped choose coverage:
– Myself-39%
– Work/HR-37%
– Friends/family-10%
Health Status
100%
5%
90%
80%
12%
39%
31%
70%
16%
37%
40%
60%
Fair/Poor
50%
40%
46%
30%
38%
43%
Good
30%
20%
10%
18%
0%
Employer
Insured
17%
8%
4%
Not
Employer
Insured
IowaCare
2013
11%
Medicaid
2011
Very Good
Excellent
Current coverage meets needs
40%
35%
36%
31%
30%
33%
29%
24%
25%
22%
Employer Insurance
20%
15%
10%
15%
Not Employer Insurance
9%
5%
0%
Public Insurance rated higher for kids than private: IA Household Health Survey
Current cost: Delayed care
80%
71%
70%
60%
50%
Employer Insurance
40%
30%
30%
Not Employer Insurance
20%
10%
0%
Yes
Out of pocket costs and worry about costs much greater for non-employer group
Importance of coverage: self/family
100%
90%
80%
70%
89%
92%
71%
Self: Employer Insurance
60%
Self: Not Employer
Insurance
-
50%
40%
All Family
30%
20%
10%
0%
18%
9%
20%
5%
2%
3%
1%1% 0
How much HEARD about ACA
100%
15%
90%
80%
38%
70%
57%
60%
A lot
50%
40%
Some
46%
Not much
30%
43%
20%
10%
0%
15%
1%
Employer Insured
4%
Not Employer Insured
Not sure
How much KNOW about ACA
100%
90%
9%
80%
70%
9%
27%
48%
60%
A lot
50%
35%
40%
30%
20%
10%
0%
Something
Heard of but
33%
Not anything
24%
9%
1%
Employer Insured
6%
Not Employer Insured
Not sure
Support/Knowledge of ACA
100%
90%
91%
86%
85%
80%
70%
60%
50%
40%
30%
80%
73% 70%
68%
58%
43%
36%
41%
40%
64%
58%
44%
52%
45%
29%
20%
10%
0%
Support=Strongly and support; Know=strongly and know
Support
Know
Knowledge less, support similar, :
For those most likely to use Marketplace
Knowledge
• Less for all areas
Support
• Age 26 coverage less (83% vs 69%)
• Marketplace credits more (65% vs 57%)
How learned about ACA
• Television: 54%
– Employer 58%
– Non employer 46%
• Newspaper: 41%
– Employer 47%
– Non employer 23%
• Family/friends: 35%
– Employer 36%
– Non employer 28%
• Public health
agencies: 29%
– Employer 34%
– Non employer 16%
– Employer 36%
– Non employer 30%
• Internet: 33%
Radio 27%; All others less than 20%: HI agents, Direct Mail, informational
meetings at Hosp, Brochures at MD, Public forums, social media
Factors affecting choice of plan*
90%
80%
70%
60%
83%
72%
79%
71%
77%
70%
65%
55%
50%
40%
38%
38%
39%
Current
28%
30%
22%
17%
20%
10%
0%
*Percentage Responding Very Important
Few differences between groups
Future
Preference for number of plans
100%
90%
80%
6%
15%
1%
13%
Not sure
70%
47%
60%
50%
57%
A moderate
number
40%
30%
20%
10%
39%
23%
0%
Employer Insured
Just a few
Not Employer Insured
As many as
possible
Choice guidance preference
100%
3%
90%
7%
Not sure
80%
70%
53%
60%
55%
50%
Guide to best
plan
40%
30%
30%
22%
14%
17%
Employer Insured
Not Employer Insured
20%
10%
Combination
0%
Simply show
options
Comfort w/online system choosing plan
100%
5%
90%
80%
26%
8%
29%
70%
60%
50%
28%
24%
40%
30%
Not Comfort
Somewhat
24%
19%
20%
10%
Not Sure
Comfortable
Very Comfort
17%
20%
Employer Insured
Not Employer Insured
0%
Need for help with online system
100%
90%
80%
4%
2%
17%
4%
1%
12%
70%
42%
60%
50%
52%
None
40%
Very little
30%
20%
10%
Not Sure
40%
25%
0%
Employer Insured
Not Employer Insured
Some
A lot
Preference for how to get help: Marketplace
60%
50%
57%
47%
43%
41%
40%
30%
32%
30%
27%
26%
30%
23%
Employer
22%
21%
20%
Not
Employer
10%
3%
1%
0%
How much help with plan info: Marketplace*
50%
45%
40%
35%
30%
25%
20%
43%
37%
39%40%
35%
30%
30%
23%
25%
19%
25%
22%
Employer
Not
Employer
15%
10%
5%
0%
*Percentage Responding A lot of help
Confidence in sources for help*
70%
60%
50%
40%
30%
65%
56% 54%
55% 56%
54% 56%
54%
51%
48%
45% 44%
45% 44%
39%
39%
34%
33%
28%
22%
20%
10%
0%
*Percentage Responding Confident or Very Confident
Employer
Not
Employer
Plan information post-purchase help
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
77%
75%
75%
65%
67%
58%
60%
55%
65%
53%
44%
52%
48%
48%
41%
40%
Employer
Not
Employer
Trusted sources for post-purchase help with
previous services
60%
56%
53%
50%
40%
30%
20%
10%
0%
44%
36%
39%
34%
28%
31%
29%
29%
Employer
26%
26%
19%
14%
Not
Employer
Top 5 most trustworthy sources of
Marketplace information
60%
55%
49%
50%
40%
30%
20%
10%
0%
40%
43%
28%27%
29%
24%
23%24%
Employer
Not
Employer
Conclusions:
For those most likely to use Marketplace
• Current situation worse
• Much less aware and knowledgeable about
change
• Similarly supportive
• Need help with choice
– Not as comfortable with on-line system
– Want one on one help
Conclusions: General
• Cost most important for choice of marketplace plan
• Most likely to learn about Marketplace from:
– Employer, TV
• Trusted sources for marketplace information
– Work HR, Public Health Agencies
• Trusted sources for marketplace purchase help
– Work HR, Print, Community resources
• Trusted sources for post-purchase help
– Work HR, Marketplace website, Community resources,
providers
– Preferred Marketplace name over Exchange
COMMUNITY CARE COORDINATION
VISION

To develop regional community care coordination
entities across Iowa to coordinate care for high-risk
patients and to support primary care providers.
GOALS




Provide assistance to local primary care providers to meet
the unique needs of their highest risk patients
Deploy care coordinators and additional support to help
assist practices in providing services for their highest need
patients such as targeted disease and care management
interventions, addressing gaps in care, education, selfmanagement support, transitional care, connection to
community resources, pharmacy management, and
behavioral health management
Improve quality, population health, and cost of care at local
level
Develop regional community care coordination entities that
become extension of primary care teams
GOALS, CONT.




Engage practices in quality improvement initiatives
Establish connections with other community resources to link
patients to support systems that address social and behavioral
needs
Demonstrate value of community care coordination and
linkages to community resource approaches to payors in
meeting the Triple Aim goals
Foster community innovation and response by building upon
local champions and early adopters
TARGET POPULATION
WHO NEEDS OUR HELP THE MOST?



Current and new Medicaid members and the uninsured
population
Definition of Safety Net population
 Under 138% federal poverty level
 Individuals without a medical home
 Uninsured and underinsured
Examples:


People showing up in the ER that do not require admission
People in need of pain management coordination and
services
IMPLEMENTATION STEPS

Conduct community outreach and education
sessions in partnership with an outside technical
assistance provider from a state already engaged
in building this type of infrastructure.
Bring together partners
 Identify clinician champions


Execute and monitor contracts for at least two and
no more than three developmental regional
community care coordination entities.
IMPLEMENTATION STEPS, CONT.
Develop state-level infrastructure to support
regional community care coordination entities
and local practices based on community
outreach and education sessions and barriers
identified through the RFA process.
 Develop an evaluation plan for the regional
community care coordination entities and
statewide entity.

TIMELINE FOR IMPLEMENTING THIS
MODEL

The Iowa Primary Care Association has a
contract with the Iowa Department of Public
Health to implement this model which
includes the following:
 Planning and Model Development: July –
September 2013
 Implementation of State Level Resources:
October – December 2013
 Regional Implementation: December
2013 – June 2014
TIMELINE FOR IMPLEMENTING THIS MODEL,
CONT.

Below are several high-level phases of implementation for
the model for care coordination entities:
 Letter of Intent Released August 12, 2013
 Letter of Intent Due September 13, 2013
 Release of Request for Proposal September 23, 2013
 Answers to Questions Posted As available
 Proposals Due by 5 pm CT October 25, 2013
 Contract Award Notification November 15, 2013
 Begin Work December 2, 2013
 Contract End Date June 30, 2014
RFP DEVELOPMENT







Timeline of Key Dates
Background
Eligible Applicants and
Entity Qualifications
Scope of Work
Data and Reporting
Requirements
Alignment with key state
initiatives already in place
Plan for Partnerships







Provider Champions
Anticipated Challenges and
Technical Assistance
Needs
Budget and Budget
Narrative
Financial Documents
Plan for Sustainability
Evaluation and Selection
Process
Appendices
LESSONS LEARNED
Primary care is foundational
 Data essential (timely and patient specific)
 Additional community based resources to help
manage populations needed (best is located in
practice)
 Collaborative local networks builds local
accountability and collaboration
 Physician leadership essential
 Must be flexible (health care is local) and
incremental
Levis Hewson, CCNC
Denise
Make
wise choices of initiatives (where you can

CARE COORDINATION ENTITY
WHAT IS A SAFETY NET CARE COORDINATION
ENTITY?



The business entity that will oversee care
coordination by and within Safety Net providers on
behalf of Safety Net patients
… that could participate in financial arrangements
that incentivized performance against Triple Aim
Goals
… and provide the infrastructure to efficiently
manage the clinical and payment needs that span
the payers of care and the providers of care.
WHAT IS A SAFETY NET CARE COORDINATION
ENTITY?

The envisioned CCE would follow similar
guiding principles as a CMS ACO:
A
group of providers that voluntarily work together…
 To coordinate care for a defined population of
patients with a goal of reducing waste and
unnecessary care…
 And participates in the financial rewards when
costs are reduced and quality is achieved.
HOW WOULD THIS ENTITY BENEFIT THE STATE
OF IOWA?
Focus on achievement of Triple Aim goals.
 Coordination of programs across multiple
payment sources.
 Ability to serve as the vehicle to modify payment
methodologies to safety net providers.
 Delivers more robust technology infrastructure to
better coordinate care.

WHO WOULD BE THE PARTICIPANTS?

Formal participants
Iowa PCA
 A care coordination infrastructure partner
 The member organizations of the Iowa Collaborative
Safety Net Provider Network


Other participants
Non-safety net hospitals
 Other settings of care
 Insurers

WHAT NEEDS TO HAPPEN?

Develop payment methodology with the State:
Build on existing base-payments
 Determine population cost goals and shared-savings
"corridors"
 Establish measures of quality


Develop internal funds distribution methodologies
Align each organizations compensation with the
methodology determined at the State level
 Set internal standards for clinical, operational, and
financial performance

WHAT NEEDS TO HAPPEN?

Create payment technology infrastructure





Actuarial evaluations
Risk adjustment
Total medical expense measurement
Performance measurement and reporting
Design and implement care coordination programs and
standards, create provider technology infrastructure




Identify high-priority care coordination goals
Develop necessary participation agreements
Assess gaps in existing infrastructure
Create capacity to evaluate Total Medical Expense and
prioritize interventions
PROGRAM GOALS
Reduce Medicaid and other spending increases
 Improve measurable quality of care
 Expand medical decision making across settings
of care
 Real-time identification of waste in the system
and appropriate responses

REQUEST FOR INFORMATION PROCESS

Need to identify a single partner or a group of
partners that is (are) qualified in the building of
necessary care coordination and payment
infrastructure to create a single organizational
structure which coordinates care on behalf of
Safety Net health beneficiaries served by safety
net providers and to participate in new models
of health care payment.
REQUEST FOR INFORMATION PROCESS
Company Background
 Input on Governance
 Input on Service Delivery Model
 Input on Payment Models
 Input on Advocacy Options
 Input on Technology

SIM ALIGNMENT

Desire to have both community care
coordination and care coordination entity
development align with the SIM planning
process recognizing the needs of safety net
patients differ than commercially and
Medicare-insured populations.
RHC PRACTICE TRANSFORMATION LEARNING
COLLABORATIVE

Background – RHCs have little capacity for practice
transformation/medical home, making it hard to
participate in payment reform, other programs

Partners – Telligen, Iowa Association of Rural Health
Clinics, Iowa PCA, CoOportunity Health

Overview – Learning collaborative with RHCs

Next Steps – Planning phase through September,
implementation October – October 2014
OUTREACH AND ENROLLMENT STRATEGY

Mark Your Calendar—October 23

What are you currently doing?

What types of resources would you like to see?