Health Care Safety Net in Iowa Post-Health Care Reform
Insurance expansion and other provisions of the Patient Protection and Affordable Care Act (ACA) has the potential to significantly alter the financing and patient populations of the health care safety net. This study is one of four projects funded by The Commonwealth Fund (i.e., Harvard, Rand and the National Academy for State Health Policy) assessing the impact of the ACA on the safety net. This project is using Iowa as a laboratory to evaluate the potential impacts of the ACA on states and identifying opportunities for integration and coordination of safety net providers and payers into the rest of the health care delivery system. The Wellmark Foundation has also contributed support for this project.
The primary objectives of this study are to:
- Inventory the current funding, expenditures, and infrastructure of the health care safety net at the state level, using Iowa as an example.
- Evaluate the potential implications of the ACA on funding, expenditures and capacity of the safety net.
- Develop and evaluate strategies for improving integration and coordination of safety net providers and organizations within the health care delivery system such as community care teams and Accountable Care Organizations (ACOs).
This project is emphasizing the impact of the ACA on the primary care safety net; for this study it is defined as:
- Providers-primary care safety net:
- Federally Qualified Health Centers (FQHCs), Rural Health Clinics, Title X funded Family Planning Clinics, Free Clinics, and Adult community-based mental health
- Payers-primary care safety net:
- Medicaid, Children's Health Insurance Program (CHIP), Medicare, Ryan White, IowaCare
- Other services-primary care safety net
- Oral health, public health and other block grants, uninsured
The project is being guided by state and national experts in the field including:
[collapsed title="Steering Committee"]
- Chris Atchison
Co-Chair, Iowa Safety Net Network Advisory Group Professor, UI College of Public Health former Director of the Iowa Department of Public Health - Ted Boesen
Executive Director,Iowa Primary Care Association (IAPCA) Co-Chair, Safety Net Network Leadership Group - Peter Damiano
Steering Committee Chair Director, UI Public Policy Center Professor, UI College of Dentistry - Keith Mueller
Professor and Head, UI Department of Health Management and Policy - Jennifer Steenblock
Iowa Medicaid Enterprise
[/collapse] [collapsed title="State Leadership Group"]
- Chris Atchison
University of Iowa College of Public Health - Ted Boesen
Executive Director,Iowa Primary Care Association (IAPCA) Co-Chair, Safety Net Network Leadership Group - Valerie Campbell
St. Luke’s Hospital - Libby Coyte
Redfield Medical Center - Stacey Cyphert
University of Iowa University Hospital - Pete Damiano
University of Iowa Public Policy Center - Julie Frischmeyer
University of Iowa Child Health Specialty Clinics - Wendy Gray
Free Clinics of Iowa - Michelle Holst
Center for Health Workforce Planning Iowa Department of Public Health - Kelly Huntsman
Primary Health Care, Inc. - Cheryll Jones
State Board of Health - Molly Lammers
Dubuque Visiting Nurse Association - Jennifer Lightbody
Peoples Community Health Clinic - Keith Mueller
University of Iowa College of Public Health - Tom Newton
Wellmark Blue Cross Blue Shield - Sandy Pickup
Iowa City Free Medical Clinic - Deb Prins
Baum Harmon Mercy Clinics - Sabra Rosener
Iowa Health Systems - Peggy Stecklein
Dallas County Public Health - Jennifer Steenblock
Iowa Medicaid Enterprise - Mikki Stier
Broadlawns Medical Center - Jodi Tomlonovic
Family Planning Council of Iowa
[/collapse] [collapsed title="State Advisory Group"]
- Christopher Atchison
Advisory Group Chair University of Iowa College of Public Health - George Bergus
Family Medicine University of Iowa - Valerie Campbell
St. Luke’s Hospital - Kyle Carlson
Planned Parenthood of the Heartland - Anthony Carroll
Associate State Director of Advocacy AARP Iowa - Libby Coyte
Redfield Medical Center - Stacey Cyphert
University of Iowa University Hospital - Pete Damiano
University of Iowa Public Policy Center - Michele Devlin
Project Export Center of Excellence on Health Disparities University of Northern Iowa - Steve R. Eckstat
Iowa Academy of Family Practice - Wendy Gray
Free Clinics of Iowa - Jack Hatch
Iowa State Senate - Deborah L. Herzberg
Davis County Hospital - John Hostetler
Community and Family Resources - Kelly Huntsman
Primary Health Care, Inc. - Julie Kuhle
Iowa Foundation for Medical Care - Jennifer Lightbody
Executive Director Peoples Community Health Clinic - Kathie Lyman
Polk County Medical Society - Dennis I. Mallory
Tama County Board of Health Mallory Medical Center - Mary Mariani
Iowa Dental Association - Julie McMahon
Iowa Department of Public Health - Linda Miller
Iowa House of Representatives - Keith Mueller
University of Iowa College of Public Health - Tom Newton
Wellmark Blue Cross Blue Shield - Lynh Patterson
Government Relations Manager Delta Dental of Iowa - Sandy Pickup
Iowa City Free Medical Clinic - Bob Russell
Iowa Department of Public Health - Dana Shaffer
Des Moines University - Cathy Simmons
Iowa Health - Cynthia Steidel
Eyerly Ball - Mikki Stier
Broadlawns Medical Center - Tom Temple
Iowa Pharmacy Association - Audrey Vaughn
Principal Financial Group - Jennifer Vermeer
Iowa Medicaid Enterprise - Kathy Walton
Iowa Medical Society - Steven Wolfe
University of Iowa Hospitals & Clinics Family Medicine
[/collapsed] [collapsed title="National Advisory Committee"]
- Judy Baker
US Department of Health and Human Services/HRSA - Bill Finerfrock
Capitol Associates (RHCs) - Dan Hawkins
National Association of Community Health Centers - Catherine Hess
National Academy for State Health Policy - Andrew Hyman
Robert Wood Johnson Foundation - Leighton Ku
George Washington University - Ed Schor
The Commonwealth Fund - Barbara Wynn
RAND Corporation
[/collapse]
The four phases incorporate background research, analysis of the ACA law and associated implementation, analysis of the gaps in knowledge, an assessment of the impact of the law on the safety net funding and delivery of services, and identification of opportunities for integration and coordination with the private sector.
[collapsed title="Project phases in more detail"]
Phase 1 (Complete):
Introductory phase—identified data sources and analyzed the financial and organizational structures of the safety net providers in Iowa, and conducted a literature review. The National Advisory Committee (NAC), and State-Level Leadership and Advisory Groups were selected.
Phase 2 (Complete):
Following the preliminary data collection and consultation with the advisory committees, three subcommittees were established:- Primary care safety net provider-FQHCs/RHCs
- Primary care safety net payer-Medicaid
- Primary care safety net service-Oral health
Phase 3 (Complete):
Additional funding and technical assistance was obtained to support the activities of the subcommittees including a grant from the Dentaquest Foundation, and a technical assistance award from the National Academy for State Health Policy (NASHP) and a contract with the Iowa Department of Public Health to explore consumer and business attitudesPhase 4 (Complete):
Inventory reports for the 5 safety net providers, 5 safety net payers, oral health, public health programs and the uninsured were compiled, detailing the revenue, expenditures, patient populations and utilization of services. The safety net provider reports also included a legal analysis compiling and summarizing all of the language in the Affordable Care Act pertaining to each provider.Phase 5:
Policy Briefs—five policy briefs are being developed from the background research and data collection:
- Attitudes of consumers entering the Health Insurance Marketplace and the health status of those most needing coverage
- Financing of the safety net and revenue projections for FQHCs
- Capacity for services at FQHCs and RHCs
- Community care team development in era of ACOs
- Oral health safety net-public and private capacity
Phase 6:
Strategy development—the Steering Committee and University of Iowa Public Policy Center staff will draft a set of potential strategies for improved integration and coordination within the safety net including the development of community care teams and health homes. An iterative process will be used to incorporate feedback from the NAC and State Leadership and Advisory Group members on an ongoing basis. Subcommittees will also be utilized to delve more deeply into the implications of strategies for particular types of safety net providers (e.g., FQHCs) or particular types of services (e.g., oral health) that may be particularly affected by the anticipated changes.[/collapsed]
These activities will help provide policymakers and providers in Iowa and other states with information concerning the impact of the ACA on the health care safety net and best practice models to integrate safety net services efficiently and effectively into the overall health care delivery system.
Additional support for this project has been provided by the Wellmark Foundation, NASHP and the Dentaquest Foundation.
Inventory reports on the safety net providers and payers in Iowa is posted on this web site (on top right area of this website).
If you have questions or comments about the project, please contact Peter Damiano: peter-damiano@uiowa.edu.