Public Health and the ACA Iowa Department of Public Health Office of Health Care Transformation Angie Doyle Scar Abby Less

Iowa Initiatives  Community Care Coordination Project  State Innovation Model  Health Insurance Marketplace  Iowa Heath and Wellness Plan  Healthy Behaviors Program  IDPH Affordable Care Act Impact Study

Community Care Coordination Project 3  Purpose: Development and implementation of a statewide regionally based network to provide an integrated approach to health care delivery through care coordination that supports primary care providers and links patients with community resources necessary to empower patients in addressing biomedical and social determinants of health to improve health outcomes.

Community Care Coordination Teams

Accountable Care Organizations

ACO and Managed Health Care Definitions 9  An accountable care organization (ACO) is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.  The term managed health care is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, for organizations that use those techniques or provide them as services to other organizations, or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts.

SIM Round One: Design  Eight month design grant awarded February 2013  Submitted design in December 2013 o State Healthcare Innovation Plan (SHIP), o Five year visionary plan  19 required components, including: o Vision statement for system transformation o Well-defined “AS IS” and “TO BE” for transformed state o Barriers and opportunities o Population health status, social/economic impacts on health o Timeline  Iowa’s SIM Website: 10

SIM Round Two: Test  On December 16, 2014 CMS announced o 11 Test states ($620m) includes Iowa! o 21 Design states ($43m) o Iowa received approval for $43.1m over 4yrs o Funds released 1 year at a time  One pre-implementation year & three test years o Each year the state requests a non-competing extension to draw down more funds 11

12 Recently Announced SIM Awards

Model Testing Proposal Iowa must apply policy and regulatory levers to address three focus areas: 1. Transform health care delivery systems 2. Improve population health 3. Decrease per capita total health care spending 13

Transform Health Care Delivery Expand ACO Model to Full Medicaid Expand PCP Assignment Shared Savings with Risk Incrementally add LTC/BH Services Care Coordination payments for chronics (aligned with HH) Align with Other Payers Use VIS Develop VIS Star Rating Include Medicaid HMO/CHIP Plans Support ACO Delivery System Develop Community Care Teams Develop Admission Discharge Transfer (ADT) system (HIT/IHIN) Technical Assistance approach with IDPH 14

Improve Population Health Improve Population Health/ Healthiest State Initiatives Tobacco UseDiabetes Obesity/Childhood Obesity Hospital Acquired Infections Obstetrics Adverse Events Engage Patients/Improve Health Literacy Build from Healthy Behavior Program Use HRA to measure Patient activation Utilize Public Partnerships for education & outreach Measure Member Experience Choosing Wisely Campaign Collect Social Determinants of Health Impact Individual patient care Implement Community SDH Transformation grants Study potential risk adjustment on ACO payment model 15

Decrease Per Capita Health Care Costs Evaluation and Monitoring Conduct Rapid Cycle Evaluations Track Total Cost of Care Public Reporting of Results Achieve Scale within an ACO model Align and partner with Public Payers (CHIP/M-HMO) Align and partner with Private Payers Track VIS Improvement Monitor VIS and TCOC relationship Identify sub populations needs improvements 16

Iowa’s Health Insurance Marketplace 17 Iowa Enrollment: (November 15, 2014 – January 16, 2015)  36,718 Iowans selected a Marketplace plan  42% are new consumers  58% are consumers reenrolling in Marketplace coverage  30% are under age 34  57% selected a Silver Plan  86% received financial assistance Source: nt.pdf nt.pdf

Iowa’s Navigators

Special Enrollment  May enroll or change Qualified Health Plan Within 60 days in individual market and 30 days in small group market from qualifying event 19 Special Enrollment Period Qualifying Events Loss of minimum essential coverage Material contract violations by Qualified Health Plans Gaining or becoming a dependent Gaining or losing eligibility for premium tax credits or cost sharing reductions Gaining lawful presenceRelocation resulting in new or different Qualified Health Plan selection Enrollment errors of the MarketplaceExceptional circumstances* * May be granted on a case by case basis.

Where States Stand on Medicaid Expansion Decisions *Map updated February 6, 2015

21 Iowa Health and Wellness Plan Began January 1, 2014 Iowans age Income up to and including 133% of the Federal Poverty Level (FPL) New, comprehensive program replaced the IowaCare program, which ended December 31, 2013 The Iowa Health and Wellness Plan was enacted to provide comprehensive health coverage for low-income adults

22 Iowa Health and Wellness Plan Enrollment

23 One Plan, Two Options Iowa Wellness Plan For adults age Income up to and including 100% of the Federal Poverty Level Iowa Marketplace Choice Plan For adults age Income 101% to no more than 133% of the Federal Poverty Level

24 Iowa Wellness Plan: 0-100% FPL Family of one $11,670 Family of two $15,730 Individuals up to 100% FPL

25  Quick Facts Administered by Iowa Medicaid Uses Iowa Medicaid provider network Offers comprehensive set of benefits Uses a primary care case management (PCCM) program, referred to as managed care Primary Care Patient Manager, or primary care provider (PCP) coordinates care and referrals for the member Iowa Wellness Plan: 0-100% FPL

26 Marketplace Choice Plan: % FPL Family of one $11,671- $15,521 Family of two $15,731- $20,920 Individuals 101% FPL up to 133% FPL

27 Healthy Behaviors and Monthly Contributions Iowa Wellness Plan Contribution: $5 per month Iowa Marketplace Choice Plan Contribution: $10 per month No copayments except for using the emergency room when it is not an emergency No monthly contributions during the first year (2014) No contributions for those with income below 50% FPL

28 Healthy Behaviors and Monthly Contributions Monthly contributions waived beginning in 2015 if the member completes wellness activities First year members need to complete health risk assessment and wellness exam (annual physical)

Healthy Behaviors Completed in o 28,841 Health Risks Assessments o 30,546 Wellness Exams o 15,626 members completed both activities

30 Began May 1, 2014 Adequate reimbursement rates for dental services Contracting with a commercial dental plan to cover services & Provider Network Population health approach Member incentives: providing basic services, with ability to earn higher cost restorative services Dental Wellness Plan

31 Medically Exempt Members who are considered ‘Medically Exempt’ must be given the option of enrolling in regular State Medicaid Plan or Wellness Plan ‘Medically Exempt’ includes individuals with disabling mental disorders (including adults with serious mental illness), individuals with chronic substance use disorders, individuals with serious and complex medical conditions, individuals with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living, or individuals with a disability determination based on Social Security criteria

32 Application Process APPLICATION PROCESS DHS Contact Center Federal Health Insurance Marketplace DHS website dhsservices.iowa.gov DHS Local Offices

33 Iowa Health and Wellness Plan Information Find up-to-date information on the Iowa Health and Wellness Plan at:

IDPH Affordable Care Act Impact Study 34  The study focuses on three areas: covered populations, covered benefits, and provider networks. In summary, the final report projected the following:  Overall demand for IDPH-funded substance abuse treatment is projected to initially decrease and then remain level through 2017, with IDPH responsible for a reduced percentage of outpatient treatment services and all residential treatment.substance abuse treatment  Demand for home care aide and nursing services will not change, primarily because the covered population is generally aged 65 and older, and therefore not eligible for ACA enrollment.home care aide and nursing services  Demand for tobacco Quitline and tobacco-related cessation services is projected to increase as such services are not currently available in some new health plans.Quitlinetobacco-related cessation services  Demand for cervical cancer screening and other preventative services is projected to decrease as historically eligible women become enrolled in new health plans.cervical cancer screening  IDPH is now working with Milliman on a similar analysis of four more direct healthcare services programs: Chlamydia Testing and the Ryan White program, Oral Health Sealant Dental Services, Title V Maternal and Child Health, and Title X Family Planning.

Questions? Contact Information:  Angie Doyle Scar  Abby Less