IowaHealth+ Update April 2019
Who We Serve (2018 numbers) 779,547 PATIENT VISITS 216,738 TOTAL PATIENTS 3,618 VETERANS SERVED 10,013 HOMELESS PATIENTS
Iowa Policy Environment • Generally a moderate state politically but prone to big swings in political control • Marginal extra state support for safety net providers but relatively generous programs and favorable policies • After big political battle, expanded Medicaid in 2014 • State had started moving toward value-based pay in Medicaid in early 2010s, including PCMH push, health homes, ACO authorization • Successfully lobbied to have FQHC-led ACO for expansion program pre-managed care • State moved to managed care in 2016 • Rollout was too quick, all populations in on day one, underfunded capitation payments • Four plans initially selected • One was forced out, two have now failed, and a fifth is now entering the market July 1 • Iowa PCA serves as liaison between MCOs, State, and CHCs • Provider agreement contract review • Revenue cycle management • Communication locus • Value-based purchasing (IowaHealth+)
Future State We’re Preparing For Value Based Care Uncertain federal & Payment funding There’s opportunity here if we’re Increasingly Payor agnostic ready competitive patient care healthcare sector
IowaHealth+ = Integrated Primary Care Network IowaHealth+ is a voluntary business venture owned and managed by 11 Iowa health centers and the Iowa PCA. 170,000+ 58,000+ Patients served Attributed Medicaid in 2018 lives in 2018 • Initially created in 2011 to apply for a Medicare ACO opportunity in partnership with the AllianceChicago • Repurposed for Medicaid Expansion MCO in 2014; hired Optum to manage • Passed UHC integration test in 2015 to begin serving as Medicaid MCO in 2016 under managed care; hired in-house expertise
The Value of IowaHealth+ Within the context of an ever-changing healthcare environment and accelerating pressure to move to value-based care/payment, IH+ facilitates: • Safeguarding our mission • Ensuring we are not subsumed by larger systems, relieving pressure to align with one system over another, safeguarding ability to partner with other providers • Building and better leveraging capacity and economies of scale, sharing investment and risk, (i.e. analytics, performance improvement, etc.) • Proactively defining our path forward and holding each other accountable to shared standards • Developing statewide primary care-focused system of care that more fully leverages our integrated model & reinvests in it • Ensuring vulnerable patients’ access to care within a larger system and grow market share • Providing one-stop shop for patients/payors/partners ( negotiating power, influence, administrative ease ) • Empowering practice transformation and value-based payment reform
IowaHealth+ Governance Structure IowaHealth+ is a limited liability corporation fully owned by 11 Iowa health centers and the Iowa PCA. Operations are supported through a management agreement with the Iowa PCA. Board of Managers All Members • Consists of four health center CEOs selected • Full ownership of IH+, has authority to by All Members and the Iowa PCA CEO, accept new members/owners, remove a functions similar to an Executive Committee member/owner, request a capital • Meets monthly to advise and direct contribution from members/owners, and operations authorize financial distributions to member/owners • Typically meets bi-monthly
IowaHealth+ Committees IowaHealth+ has three working committees composed entirely of health center representatives. Participation in the committees is an IH+ participation standard. Consumer Advisory Clinical Quality Committee Provides advice to the Board on policies and Provides advice to the Board on clinical and quality programs including: matters, including: • related to cultural competency • quality improvement programs • outreach plans • recommended clinical pathways and protocols • beneficiary educational materials, prevention • participant quality incentive targets and programs, and satisfaction surveys satisfaction thereof Finance Provides advice to the Board on financial matters, including: • developing capital and operating budgets • financial forecasting • reviewing financial statements • engaging auditors to the extent deemed necessary by the Board
IowaHealth+ Participation Standards IowaHealth+ participation standards are established by IowaHealth+ member/owner centers in order to pursue continuous improvement and hold each other accountable to shared goals. Clinical Consumer Clinical Standards This committee has the first opportunity to develop a Finance All Member Quality Advisory proposal, whether to edit or delete a current standard or to create a new standard. This Hypertension Lead Support Informed Ratify Lead committee is expected to give due consideration to Colorectal Cancer Screening Lead Support Informed Ratify feedback and recommendations made by the Supporting committee, but has authority to submit a Financial Standards final recommendation to the Ratifying committee. Initial Capital Contribution Informed Informed Lead Ratify This committee offers feedback and Capacity Planning Model Informed Informed Lead Ratify Support recommendations based on the initial proposal developed by the "Lead" committee. Operational Standards This committee is kept informed of any changes to Teach-back Support Lead Informed Ratify Informed the participation standards, but doesn't have a role in developing recommendations. Outreach & Enrollment Support Lead Informed Ratify This group has the authority to approve and codify Committee Participation Support Support Support Lead, Ratify Ratify changes to the participation standards. Use of Data (VIS) Support Support Support Lead, Ratify PCMH Certification Support Support Support Lead, Ratify Transformation Collaborative Support Support Support Lead, Ratify Participation Brand Integration Support Support Support Lead, Ratify
History of Innovation & Partnership: Medicaid Prior to Managed Care Iowa Medicaid Healthy Behaviors In 2015, IowaHealth+ was the highest performing ACO in Iowa for the wellness exam (68%) and the second highest performance ACO for the HRA (34%). IowaHealth+ tied with UIHA as the top-performing ACO for patients completing at least one activity and second highest for patients completing both activities.
History of Innovation & Partnership IowaHealth+ partners Project ECHO for BH IowaHealth+ has with IDPH to address integration, MAT, and HEP C partnered with DHS HTN, CRCS, ER – more to come before and after utilization, etc. managed care. IowaHealth+ centers have participated in the NACHC Value IowaHealth+ participates IowaHealth+ participated in Transformation and Elevate. in the 2018-19 behavioral the 2016-17 SNAC learning health integration & action collaborative. collaborative.
History of Innovation & Partnership SIM dollars support rollout of PRAPARE Two-year partnership increased rates of tool across all IowaHealth+ centers; Iowa same-day access, ER and IP follow-up, and PCA primary consultant to providers and PCP visits for high risk patients. communities on SDOH. Multiple partnerships since managed care rollout, focused on data sharing and quality measures.
Clinical Integration
Quality & Transformation • Implementation arm for the three companies • Interdisciplinary team to support health centers • Clinical informaticist • Nurse • Behavioral health specialist • Oral health specialist • Data analyst • Share best practices, network, and share decision-making through: • Clinical Quality Committee, Consumer Advisory Committee, Finance Committee & Care Coordination Workgroup • Regular in-person learning collaborative • Health center on-site assessment and support for collective and local clinical quality and performance improvement priorities (quality, cost, patient experience, staff fulfillment) • Provide leadership and support for data analysis and reporting, business and population health strategy to improve outcomes and lower costs
Quality & Transformation: IH+ Model of Care IowaHealth+ Model of Care Manage Patient Care Improve High Risk Provide High Quality Ensure Patients’ Social Determinants Integration of Care Transitions Care Coordination Care Timely Access to Care of Health Supported by Health Information Data and Analytics • VBC Analytics & Enli implementation Supported by Patient Engagement Strategies • Motivational Interviewing & Teach-Back
Quality & Transformation: IH+ Model of Care Ensure Patients’ Timely Manage Patient Care Integration of Care Access to Care Transitions • Behavioral Health Integration • PCMH Recognition • Transitions of Care Minimum Set Strategy of Services • Oral Health Integration Pilots • ER Utilization Reduction • Admits, Discharges, Transfer (ADT) alerts
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