IHWP Healthy BehaviorsStrategy Discussion

October 6th and 8th, 2014Iowa Primary Care Association

Impacted Medicaid Populations

• All Marketplace Choice Plan (CoOportunity Health and Coventry) patients and Wellness Plan patients (general Wellness Plan and Meridian HMO) patients must complete the Healthy Behaviors to avoid cost-sharing.– DWP patients also have to complete a risk assessment

• IHWP patients determined to be medically exempt are not subject to cost-sharing if they do not complete the Healthy Behaviors, but are encouraged to complete them.

Why are the Healthy Behaviors Important to Complete?

• Supports the patient in retaining their health care coverage– Greater likelihood for patients to access and experience

continuity in their health care• Helps waive any possible contribution (premium) for

the next year of enrollment– Premium Amounts

• Individuals with Income 0-50 Percent of the FPL: $0 (no premiums)

• Individuals with Income 50-100 Percent of the FPL: $5 per month

• Individuals with Income 100-133 Percent of the FPL: $10 per month

Why are the Healthy Behaviors Important to Complete? (cont.)

• Helps waive any possible contribution (premium) for the next year of enrollment– Nonpayment of Premiums

• Individuals with Income 50-100 Percent of the FPL: Nonpayment of premiums will result in debt subject to collection by Iowa. No loss of coverage will occur, until the time of annual renewal.

• Individuals with Income 100-133 Percent of the FPL: Nonpayment of premiums will result in disenrollment from the Iowa Health and Wellness Plan.

• For IowaHealth+ members, we must have 50% of the patients complete them to avoid a claw back of the ACO incentives by IME

Key Clarifications

• Timeline differences– Patients have one full year to complete the two Healthy

Behaviors (based on their date of enrollment into the program)

– Providers are measured on their performance on the calendar year (December 31st, 2014)

• HRA completion differences for patients versus providers– Patients must complete the HRA – Providers must incorporate the results of the patient’s

HRA into the patient’s care plan

Information on IME Reenrollment Efforts

• Former IowaCare patients’ income is subject to the new MAGI methodology which is causing some to move from the WP to the MCP or off the IHWP completely

• Former IowaCare patients are not completing the reenrollment paperwork and are dropping off the program (more info in future slides)

• Former IowaCare patients are placed into a “tentative” assignment status for 90 days and IME is now NOT including these patients in the assignments lists until their 90 day window to change their PCP assignment is up

• Patients could be changing their PCP – this can technically occur anytime during the year if the patient provides IME with an approved reason for wanting to switch their PCP outside of the 90-day tentative status period

• All the above factors except the MAGI methodology will impact Wellness Plan patients who need to reenroll into the program during the 2015 calendar year

October Healthy Behaviors Report

Assigned Patients - 8/8/14

Assigned Patients - 9/12/14

Assigned Patients - 10/6/14

Patients Enrolled 6 or More Months

HRAs Completed

HRA Completion %

Wellness Exams Completed

Exam Completion %

Patients with Both HBs Completed

Both HBs Completion %

Monthly HRAs Needed to Meet 50% Goal

Monthly Wellness Exams Needed to Meet 50% Goal

All Care 963 801 730 699 62 9% 86 12% 32 5% 96 88

CHCSEIA 40 43 43 40 7 18% 8 20% 3 8% 4 4

CHCSI 187 175 204 174 13 7% 6 3% 1 1% 25 27

Crescent 1,701 1,582 1,738 1,506 93 6% 186 12% 43 3% 220 189

Peoples 1,448 1,233 1,154 1,077 228 21% 226 21% 124 12% 104 104

Promise 17 20 24 21 8 38% 7 33% 5 24% 1 1

River Hills 428 407 433 388 106 27% 66 17% 34 9% 29 43

Siouxland 1,073 930 920 831 266 32% 198 24% 141 17% 50 73

TOTALS 5,857 5,191 5,246 4,696 776 775 380 524 524

Overall Completion Rates 17% 17% 8%

Impact of IowaCare Reenrollments

• IowaCare reenrollments occurring June through November (30 days notice)

• Have to complete renewal forms by due date otherwise their coverage will be cancelled– If turned in up to 90 days after the initial due date,

their coverage will be reinstated – means no lapse in coverage similar to retroactive coverage

– After 90 days, a new application must be submitted where only 90 days of retroactive coverage can be provided (some lap in coverage)

Impact of IowaCare Reenrollments

• Lots of movement with the IowaCare reenrollments between WP, MCP, traditional Medicaid– Always verify eligibility using the IME systems

• If members do not have their renewal form– Can use a blank form– Can contact local offices to request a new form be

mailed out– Can do a new application

Future Reenrollment Efforts

• IME getting ready to start renewals for those enrolling in January– Issued on 10/31 and due 12/31– Same renewal form as former IowaCare patients– Same 90 days available for reinstatement of coverage

if they miss their deadline• Members need to directly change their addresses

with IME/DHS– DHS customer service center is the fastest route

compared to DHS case workers

Additional Key Information• IME recently expanded the Wellness Exam criteria

– found in Informational Letter 1425• IME Informational Letter 1415 includes

information about billing for the HRA specifically for FQHCs and RHCs

• IME Healthy Behaviors Mailings• Discrepancies in data between IME reports and

FQHC reports– Lag in claims for wellness exams– HRA data is more timely, but lots of factors impacting

the reports

Discussion of Strategies to Support This Work

• PCA work to identify a process to better track patients ever assigned to a Practice Manager (PCP)

• Questions, comments, additional challenges• Health center strategies and workflows that

are working– Efforts between dental and medical

• Reminder of resources on the PCA website