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 1. Public Health Block Grant and related services 2. Uninsured in Iowa 3. Oral health Available at: care-safety-net-iowa-post-health-care-reform/inventory- reportshttp://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

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 Participation Comparisons with previous surveys Iowa

Trends in Medicaid Participation Comparisons with previous surveys

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