Peter Damiano

Director, Public Policy Center

University of Iowa

Iowa Safety Net Network State Advisory Group

November 8, 2013

Iowa Safety Net, the ACA and Related

Primary Care Delivery System Changes:

An update

• Two year grant from The Commonwealth Fund• Use Iowa as model for US on impact of the ACA on

the primary care safety net• Steering committee meets weekly to discuss

progress and related issues• Iowa Safety Net Network acts as state level

advisory group• National advisory committee also guides and helps

interpret results• Results being released in reports, policy briefs and

journal articles

Background

1. Federally Qualified Health Centers (FQHCs)

2. Rural Health Clinics (RHCs)

3. Free Clinics

4. Family Planning Clinics

5. Community-based Adult Mental Health Centers

• Includes legal analysis of the ACA as it relates to each provider type

Completed Safety Net Provider Inventory Reports(financing, delivery system, clients)

1. Medicare

2. Medicaid

3. Children’s Health Insurance Program (CHIP)

4. IowaCare

5. Ryan White

Other Reports

6. Public Health Block Grant and related services

7. Uninsured in Iowa

8. Oral health

Available at: http://ppc.uiowa.edu/health/study/health-care-safety-net-iowa-post-health-care-reform/inventory-reports

Safety Net Payer Inventory Reports(financing, clients)

Subcommittee Activities

1. FQHC/RHC subcommittee– Safety net provider

2. Oral health subcommittee– SN primary care service

3. Medicaid subcommittee– SN payer

Subcommittee activities

1. Established an FQHC/RHC subcommittee

2. Capacity of safety net: survey of FQHCs/RHCs concerning:

o Capacity for providing care currently,

o Barriers to growth,

o Interest in community utility-type functions

FQHC/RHC Subcommittee

1. Established a National Oral Health Advisory Committee

2. Inventory report on oral health in Iowa (access, utilization health status)

3. Capacity of private oral health safety net: Survey Iowa private dentists about Medicaid participation and attitudes

– Factors affecting dentist participation: Conjoint analysis survey (scenarios)

4. Capacity of public oral health safety net: survey of FQHC dental clinics

Oral Health Subcommittee

Medicaid Participation

• 58% of private dentists accept Medicaid

• 80% of dentists that do not currently accept Medicaid treated Medicaid patients in the past

16%

42%

42%

All new MedicaidSome new MedicaidNone

1. Established a National Oral Health Advisory Committee

2. Inventory report on oral health in Iowa (access, utilization health status)

3. Capacity of private oral health safety net: Survey Iowa private dentists about Medicaid participation and attitudes

– Factors affecting dentist participation: Conjoint analysis survey (scenarios)

4. Capacity of public oral health safety net: survey of FQHC dental clinics

Oral Health Subcommittee

Overall Medicaid ParticipationComparisons with previous surveys

1992 1995 2013

79%

64%58%

Iowa

Trends in Medicaid ParticipationComparisons with previous surveys

1992 1995 20130%

20%

40%

60%

80%

100%17%

35%

73%

Some MedicaidAll Medicaid

• Originally evaluating ability for Medicaid to absorb expansion

o Partially captured in the capacity survey with FQHCs/RHCs

• Now focusing on ACO, Community Care Team and health home development

o Participating in NASHP Medicaid TA project

o Community care team policy brief

o Participation of safety net providers in ACOs for policy brief

Medicaid subcommittee

CMWF Policy Briefs:

Often referring back to lengthier reports or journal articles

1. Pre and post enrollment issues for the Health Insurance Marketplace

– Combines HIM and IowaCare reports

2. Safety net provider revenue and potential impacts of ACA expansion on FQHCs

3. Capacity of FQHCs and RHCs to deal with new patients post ACA insurance expansion

– Will have two journal

4. Incorporating safety net providers into ACOs

5. Oral health safety net-public and private

6. Care coordination/care management and the role for the safety net

Policy Briefs In Progress

Discussion

Vinny