Study

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:

  1. Inventory the current funding, expenditures, and infrastructure of the health care safety net at the state level, using Iowa as an example.
  2. Evaluate the potential implications of the ACA on funding, expenditures and capacity of the safety net.
  3. 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:

  1. Primary care safety net provider-FQHCs/RHCs
  2. Primary care safety net payer-Medicaid
  3. 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 attitudes

Phase 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.