Health Policy

IowaCare Study indicates need for expanded services in ACA implementation

 

Results from the Evaluation of the IowaCare Program: Information about the Medical Home Expansion study revealed implications for the implementation of the Iowa Health and Wellness Plan, Iowa’s version of Medicaid expansion.

The results of the study indicate that the population currently served by the IowaCare program, which expires on December 31, 2013, experience significant and/or chronic health issues.  Over 60% of those responding to the survey indicated three or more chronic physical health problems, and 40% rated their own health as fair or poor, and one-third of respondents reported fair to poor mental and/or emotional health.  Dental health was rated fair or poor among 61% of the IowaCare enrollees surveyed.

Patients with significant and chronic health concerns often require coordinated care from a variety of care providers.  The IowaCare program assigns enrollees to one of five different primary-care based medical homes, based on county of residence.

Overall, respondents reported continuity of care at their assigned medical home, and expressed satisfaction with their care and communication from care providers, but level of satisfaction varied in each region.  Enrollees reported dissatisfaction in regard to access to health care after regular office hours, receiving timely feedback about care and follow-up appointments, and support for self-management of their illness.  Lack of access to after-hours care resulted in many visits to Emergency Departments that should otherwise have taken place at a clinic or doctor’s office.

Finally, almost half of IowaCare enrollees who responded to the survey reported unmet needs in prescription medications and dental and mental health care. Less than one half had had a preventive care visit in the previous six months, yet only one in five reported an unmet need for such care.  The Iowa Health and Wellness Plan incentives of premium waivers for prevention and wellness activities may encourage this population to more regularly pursue preventive care or wellness activities.

With IowaCare enrollees making up a significant portion of the population to be covered by the Iowa Health and Wellness Plan to be enacted on January 1, 2014, the results of this survey can help to inform implementation of the new plan, specifically in the areas of dental care, mental health care, and prescription medication support.  It is also important to address issues regarding access to timely care, and assess the capacity of medical home sites to manage increases in patient encounters.

The Evaluation of the IowaCare Program study was conducted by the University of Iowa Public Policy Center, led by Peter Damiano, Director, Suzanne Bentler, Research Specialist, Elizabeth Momany, Assistant Director of the Health Policy Research Program, Ki Park, Research Specialist, and Erin Robinson, Graduate Student Research Assistant.

To read a full copy of the report, click here.

See Des Moines Register article on the report here.