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Bery Engebretsen, MD, Medical Director, Primary Health Care, Inc. discusses Iowa's medicaid enterprise and lessons learned.
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Iowa Medicaid Enterprise1115 waiver expansion to FQHCs
Partners: Iowa Medicaid Enterprise (IME); Iowa Department of Public Health (IDPH); Iowa/Nebraska Primary Care Association (IANEPCA)
Preserved $60 mil when begun (loss of intergovernmentaltransfer (IGT) )
Two providers: University of Iowa (U of I), local public hospital in Des Moines. Contributed their public $$ to preserve federal match
All care to the U of I for entire state, thus used mostly for specialty care (except in Polk County where public hospital was funded)
Expanding to community health centers (CHCs) in step‐wise fashion with$6 million
Some political maneuvering about expansion sites and paceBegan 10/1/10 with two sites; next sites in MarchCHC funding for patient‐centered medical home (PCMH) only – not meds,
off site labSpecialty care must still go to the U of IInitial demand was huge for site near U of I
Defining and Recognizing• PCMH recognition required (National Committee for Quality
Assurance (NCQA) or equivalent)– “Level 1” end of 1st year– Advancing to highest level by year 2– Fee‐for‐service (FFS) payment for visit (not cost‐based or
prospective payment system (PPS) )– Plus $3.00 to $3.50 per member per month (PMPM) tied to PCMH
recognition, and $1 to $1.50 tied to outcomes– Annual outcomes (ten – all or none)
• Colorectal, body mass index (BMI), tobacco, diabetes, adult immunizations, Paps
– Various aspects of PCMH reported quarterly• Registry reports on Diabetes• EHR progress• Patient reminders, referral tracking
Lessons Learned• Unmet need is huge, even in Iowa
• Coordination is challenging without convenient geographic access
• Patient education is very important
• Time for provider planning is important
• Keep eye on the politics
• Links to:– Model
– Quarterly report
– Annual performance report