iowa collaborative safety net provide network. 12:00 pm-12:10 pmwelcome and introductions network...
TRANSCRIPT
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LEADERSHIP GROUP MEETINGAUGUST 6TH, 2013
Iowa Collaborative Safety Net Provide Network
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AGENDA
12:00 PM-12:10 PM Welcome and IntroductionsNetwork Staff
12:10 PM-12:40 PM Funding Recommendations for SFY14Network 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 EntitySarah Dixon Gale
1:40 PM-1:45 PM Rural Health Clinic Practice Transformation Learning CollaborativeNetwork Staff
1:45 PM-1:50 PM Outreach and Enrollment StrategyNetwork Staff
1:50 PM-2:00 PM Other Items, Next Steps, and Adjourn
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SFY14 BUDGET SFY13 SFY14 Request SFY14 ActualProvider Awards Rural Health Clinics $141,544 $142,192 $141,544 Family Planning Agencies $0 $100,000 $0 Free Clinics $273,322 $400,000 $348,322 Federally Qualified Health Centers $75,000 $75,000 $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 Network Management $145,785 $146,563 $145,785 Sexual Assault Response Teams $50,000 $50,000 $50,000 TOTAL $1,484,819 $1,951,946 $1,724,819
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SFY14 FUNDING RECOMMENDATIONS Rural Health Clinics Free Clinics Federally Qualified Health Centers SART Initiative Pharmacy Initiative Medical Home Specialty Care
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RURAL HEALTH CLINICS
Amount Available $141,544
Recommendation:
IARHC SupportRHC Provider Awards
$ 5,176$136,368
Eligibility for RHC Provider Awards
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FREE CLINICS
Amount Available
$348,322
Recommendation: FC Provider AwardsFree 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.
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FQHCS
FQHCs Amount Available $75,000
Recommendations Funding be allocated evenly to the state’s 14 FQHCs to support statewide reform initiatives
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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
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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
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MEDICAL HOME INITIATIVELocal Boards of
HealthAmount Available
$77,153Comments/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
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MEDICAL HOME INITIATIVEMaternal 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 •Kids and families were not a very prominent part of the proposal•Do providers include dentist?•Strong partnerships, strong agency; •Exploring ACOs
Iowa County Fund: $31,708 •Included dental component•Great abstract•A sealant program is not a dental home •What are the gaps in the obesity issues
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SPECIALTY CARE INITIATIVE
Specialty Care $378,474
Applicant Amount Requeste
d
Recommendation
Questions/Comments
Blank Children’s Hospital
$3,000
Medications for free clinic patients
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
Crawford County Memorial Hospital
$154,828
Bilingual health coach; Hispanic patients
Fund: Yes ($49,802)
•Clinical Outcome measures are ambitious but not achievable; •Should address impact of Health Care Reform•Need to revise work plan
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SPECIALTY CARE INITIATIVE
Specialty Care $378,474
Applicant Amount Request
ed
Recommendation
Questions/Comments
Polk County VPN
$237,960
Continued funding and program expansion
Fund: Yes (213,748)
•Need more detail in numbers served •Budget is staff heavy; suggest focus on sustainability •More information about how referrals are tracked
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SPECIALTY CARE INITIATIVESpecialty Care $378,474
Applicant Amount Requested
Recommendation
Questions/Comments
Primary Health Care
$135,660
Expansion of integrated behavioral health program to 2 additional sites
Fund: Yes ($114,924)
•Good job diversifying funding•Could be a statewide model•Very well leveraged; expanding•Ahead of the game
Linn County Project Access
$69,500
Project Access expansion
Fund: No •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
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SPECIALTY CARE SUMMARY
SFY13 SFY14 Request
Recommendation
Blank Children’s Hospital Free Clinic
$ 0
$ 3,000
$ 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
$ 0
Primary Health Care $114,924
$135,660
$114,924
Total $308,474
$600,948
$378,474
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Health Benefits Marketplace
Perceptions of Consumers in Iowa
Pete DamianoSuzanne Bentler
Dan Shane
Iowa Safety Net Network Leadership Group MeetingAugust 6, 2013
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In this presentation
• Consumer survey–Methods– Demographics– Insurance coverage and factors affecting choice– Knowledge and Attitudes toward the ACA–Marketplace preferences and assistance
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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
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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
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Type of Assistance
• Who helped choose coverage:–Myself-39%–Work/HR-37%– Friends/family-10%
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Health Status
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18%8% 4% 11%
46%
43%
17%
30%
31%
37%
38%
40%
5% 12%
39%
16%
Fair/PoorGoodVery GoodExcellent
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Current coverage meets needs
Excellent
Very good
GoodFair/Poor
0%
5%
10%
15%
20%
25%
30%
35%
40%
31%
36%
24%
9%
15%
29%
33%
22% Employer Insurance
Not Employer Insurance
Public Insurance rated higher for kids than private: IA Household Health Survey
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Current cost: Delayed care
Yes0%
10%
20%
30%
40%
50%
60%
70%
80%
30%
71%
Employer Insurance
Not Employer Insurance
Out of pocket costs and worry about costs much greater for non-employer group
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Importance of coverage: self/family
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%89%
9%2% 1%
71%
18% 20%
1%
92%
5% 3% 0%
Self: Employer Insurance
Self: Not Employer Insurance
-
All Family
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How much HEARD about ACA
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1% 4%15%
43%
46%
57%
38%
15%
A lotSomeNot muchNot sure
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How much KNOW about ACA
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1% 6%9%
24%33%
35%
48%
27%
9% 9%
A lotSomethingHeard of butNot anythingNot sure
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Support/Knowledge of ACA
Preexist
Prev Cov
Biz credits
Kids to 26
HBMP
Lg Biz Cover
Mcaid exp
Support HI
Ind Man
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%91%
86% 85%80%
70% 68%64%
58%
45%
58%
43%36%
73%
41% 40%44%
29%
52%
Support
Know
Support=Strongly and support; Know=strongly and know
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Knowledge less, support similar, : For those most likely to use Marketplace
Knowledge• Less for all areasSupport• Age 26 coverage less (83% vs 69%)• Marketplace credits more (65% vs 57%)
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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 30%
• Internet: 33%
– Employer 36%– Non employer 28%
• Public health agencies: 29%– Employer 34%– Non employer 16%
Radio 27%; All others less than 20%: HI agents, Direct Mail, informational meetings at Hosp, Brochures at MD, Public forums, social media
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Factors affecting choice of plan*
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
72% 71% 70%
55%
38%
28%
17%
83%79% 77%
65%
38% 39%
22%
Current
Future
*Percentage Responding Very ImportantFew differences between groups
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Preference for number of plans
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
23%39%
57%
47%
15%13%
6% 1%
Not sure
Just a few
A moderate number
As many as possible
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Choice guidance preference
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
14% 17%
30% 22%
53%55%
3% 7%
Not sure
Combination
Guide to best plan
Simply show options
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Comfort w/online system choosing plan
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
17% 20%
24% 19%
28%24%
26%29%
5% 8%
Not SureNot ComfortSomewhatComfortableVery Comfort
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Need for help with online system
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
25%40%
52%
42%
17% 12%2% 1%4% 4%
Not SureNoneVery littleSomeA lot
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Preference for how to get help: Marketplace
0%
10%
20%
30%
40%
50%
60% 57%
41%
32%
26%23% 22%
1%
47%43%
30%27%
30%
21%
3%
Employer
Not Em-ployer
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How much help with plan info: Marketplace*
Out pocket
Services
Monthly$
PlanQuality
Reputation
Providers
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
37%39%
30%
23%19%
22%
43%40%
35%
30%
25% 25%Employer
Not Em-ployer
*Percentage Responding A lot of help
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Confidence in sources for help*
0%
10%
20%
30%
40%
50%
60%
70% 65%
56% 56% 54%48%
45% 44% 44%
33%
22%
54% 55% 56% 54%51%
39%45%
39%34%
28% Employer
Not Em-ployer
*Percentage Responding Confident or Very Confident
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Plan information post-purchase help
Services
Out pocket
Monthly$
Claims pa...
Providers
Billing pro...
Adjustm...
Appeals
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
75%
65%58% 60%
44%
65%
48% 48%
77% 75%67%
55% 53% 52%
41% 40% Employer
Not Em-ployer
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Trusted sources for post-purchase help with previous services
0%
10%
20%
30%
40%
50%
60% 56%53%
34%31% 29%
26%
14%
36%39%
28%
44%
29%26%
19%
Employer
Not Em-ployer
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Top 5 most trustworthy sources of Marketplace information
Employer
Pub Hlth
Ins. agent
Fam/Frie
Brochures
0%
10%
20%
30%
40%
50%
60%55%
49%
28%24% 23%
40%43%
27% 29%24% Employer
Not Em-ployer
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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
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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
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COMMUNITY CARE COORDINATION
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VISION
To develop regional community care coordination entities across Iowa to coordinate care for high-risk patients and to support primary care providers.
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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, self-management 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
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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
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TARGET POPULATIONWHO 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
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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.
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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.
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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
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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
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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
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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 Make wise choices of initiatives (where you
can make a difference- success breeds success)
Denise Levis Hewson, CCNC
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CARE COORDINATION ENTITY
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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.
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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.
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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.
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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
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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
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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
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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
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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.
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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
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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.
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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
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OUTREACH AND ENROLLMENT STRATEGY Mark Your Calendar—October 23
What are you currently doing?
What types of resources would you like to see?