1. Iowa Collaborative Safety Net Provide Network Leadership group meetingaugust 6th, 2013

2. 12:00 PM-12:10 PM Welcome and Introductions Network Staff 12:10 PM-12:40 PM Funding Recommendations for SFY14 Network Staff 12:40 PM-12:55 PM Commonwealth Fund Project Update Dr. Pete Damiano 12:55 PM-1:15 PM Community Care Coordination Project Update Sarah Dixon Gale 1:15 PM-1:40 PM Safety Net Care Coordination Entity Sarah Dixon Gale 1:40 PM-1:45 PM Rural Health Clinic Practice Transformation Learning Collaborative Network Staff 1:45 PM-1:50 PM Outreach and Enrollment Strategy Network Staff 1:50 PM-2:00 PM Other Items, Next Steps, and Adjourn Agenda

3. SFY14 Budget

4. Rural Health Clinics Free Clinics Federally Qualified Health Centers SART Initiative Pharmacy Initiative Medical Home Specialty Care SFY14 Funding Recommendations

5. Rural Health Clinics • Eligibility for RHC Provider Awards

6. Free Clinics • Line item increase for SFY14 of $75,000 • FCI allocation would be used for state-wide support including enhancing education and access of patients from free clinics toward the Iowa Health and Wellness Plan. 

7. FQHCs

8. SART Initiative

9. Pharmacy Initiative

10. Medical Home Initiative

11. Medical Home Initiative

12. Specialty Care Initiative

13. Specialty Care Initiative

14. Specialty Care Initiative

15. Specialty care summary

16. Health Benefits Marketplace Perceptions of Consumers in Iowa Pete Damiano Suzanne Bentler Dan Shane Iowa Safety Net Network Leadership Group Meeting August 6, 2013

17. In this presentation • Consumer survey • Methods • Demographics • Insurance coverage and factors affecting choice • Knowledge and Attitudes toward the ACA • Marketplace preferences and assistance

18. Methods-Consumers • Mixed mode (On-line and written in person) • Convenience sample: • IA Caregivers Assoc. (both) • one Iowa FQHC (written) • Iowa State Extension (written) • IA Public Health Association (online) • AARP (online) • IDPH partners and local agencies • 85 questions maximum • 43 questions with some tables of multiple subquestions • 498 responses so far • 367 On-line • 131 Written

19. Insurance Coverage Types • Employer-based (<HBMP)-80% (n=396) • Non-employer-based (>HBMP)-20% (n=102) • Uninsured now or in last 12 months (5%; n=24) • Self insured (5%; n=25) • Public (10%; n=53) • Medicaid • IowaCare • CHAMPUS • VA • Military *Medicare was excluded

20. Type of Assistance • Who helped choose coverage: • Myself-39% • Work/HR-37% • Friends/family-10%

21. Health Status

22. Current coverage meets needs Public Insurance rated higher for kids than private: IA Household Health Survey

23. Current cost: Delayed care Out of pocket costs and worry about costs much greater for non-employer group

24. Importance of coverage: self/family

25. How much HEARD about ACA

26. How much KNOW about ACA

27. Support/Knowledge of ACA Support=Strongly and support; Know=strongly and know

28. Knowledge less, support similar, : For those most likely to use Marketplace Knowledge • Less for all areas Support • Age 26 coverage less (83% vs 69%) • Marketplace credits more (65% vs 57%)

29. How learned about ACA • Television: 54% • Employer 58% • Non employer 46% • Newspaper: 41% • Employer 47% • Non employer 23% • Family/friends: 35% • Employer 36% • Non employer 30% • Internet: 33% • Employer 36% • Non employer 28% • Public health agencies: 29% • Employer 34% • Non employer 16% Radio 27%; All others less than 20%: HI agents, Direct Mail, informational meetings at Hosp, Brochures at MD, Public forums, social media

30. Factors affecting choice of plan* *Percentage Responding Very Important Few differences between groups

31. Preference for number of plans

32. Choice guidance preference

33. Comfort w/online system choosing plan

34. Need for help with online system

35. Preference for how to get help: Marketplace

36. How much help with plan info: Marketplace* *Percentage Responding A lot of help

37. Confidence in sources for help* *Percentage Responding Confident or Very Confident

38. Plan information post-purchase help

39. Trusted sources for post-purchase help with previous services

40. Top 5 most trustworthy sources of Marketplace information

41. Conclusions:For those most likely to use Marketplace • Current situation worse • Much less aware and knowledgeable about change • Similarly supportive • Need help with choice • Not as comfortable with on-line system • Want one on one help

42. Conclusions:General • Cost most important for choice of marketplace plan • Most likely to learn about Marketplace from: • Employer, TV • Trusted sources for marketplace information • Work HR, Public Health Agencies • Trusted sources for marketplace purchase help • Work HR, Print, Community resources • Trusted sources for post-purchase help • Work HR, Marketplace website, Community resources, providers • Preferred Marketplace name over Exchange

43. Community Care Coordination

44. To develop regional community care coordination entities across Iowa to coordinate care for high-risk patients and to support primary care providers. Vision

45. Provide assistance to local primary care providers to meet the unique needs of their highest risk patients • Deploy care coordinators and additional support to help assist practices in providing services for their highest need patients such as targeted disease and care management interventions, addressing gaps in care, education, self-management support, transitional care, connection to community resources, pharmacy management, and behavioral health management • Improve quality, population health, and cost of care at local level • Develop regional community care coordination entities that become extension of primary care teams Goals

46. Engage practices in quality improvement initiatives • Establish connections with other community resources to link patients to support systems that address social and behavioral needs • Demonstrate value of community care coordination and linkages to community resource approaches to payors in meeting the Triple Aim goals • Foster community innovation and response by building upon local champions and early adopters Goals, cont.

47. Current and new Medicaid members and the uninsured population • Definition of Safety Net population • Under 138% federal poverty level • Individuals without a medical home • Uninsured and underinsured • Examples: • People showing up in the ER that do not require admission • People in need of pain management coordination and services Target PopulationWho Needs Our Help the Most?

48. Conduct community outreach and education sessions in partnership with an outside technical assistance provider from a state already engaged in building this type of infrastructure. • Bring together partners • Identify clinician champions • Execute and monitor contracts for at least two and no more than three developmental regional community care coordination entities. Implementation Steps

49. Develop state-level infrastructure to support regional community care coordination entities and local practices based on community outreach and education sessions and barriers identified through the RFA process. Develop an evaluation plan for the regional community care coordination entities and statewide entity. Implementation Steps, cont.

50. The Iowa Primary Care Association has a contract with the Iowa Department of Public Health to implement this modelwhich includes the following: • Planning and Model Development: July – September 2013 • Implementation of State Level Resources: October – December 2013 • Regional Implementation: December 2013 – June 2014 Timeline for Implementing This Model