The Third Way: a path forward for managing Medicaid in Iowa
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As a member of the Iowa Hospital Association (IHA) – and with our CEO Marty Guthmiller becoming the Chair of the IHA Board beginning October 10, 2018 – Orange City Area Health System would like to provide some background and context for a new IHA proposal for replacing the current Medicaid structure.
The videos (linked at the right) depict some of the current facts and challenges under Iowa’s current Medicaid Managed Care environment. They should be viewed within the context of the information provided below from the IHA:
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The Third Way: a path forward for managing Medicaid in Iowa
Roadmap for Value-Based Payment
In April 2016, the State of Iowa implemented commercial managed care for nearly all Iowans receiving Medicaid. To move toward a sustainable financial model for Medicaid and ensure high quality, efficient, and accessible care for Iowas, the Iowa Hospital Association (IHA) has proposed pivoting the State’s Medicaid program to a value-driven delivery system that:
- Establishes data-informed care management at the site of care,
- Eliminates administrative redundancy,
- Promotes transparency and accountability, and
- Moves the State to payment arrangements that reward population health improvement and program efficiency.
This new model, “The Third Way,” would replace the current system of commercial managed care with a single statewide Administrative Services Organization (ASO) responsible for supporting a standardized suite of care management and administrative functions across the State, including: streamlined and centralized provider enrollment; centralized beneficiary enrollment and attribution; standardized quality measures, clinical guidelines and care improvement initiatives with flexibility for local variation and innovation; and tools and resources to support clinical practice transformation. A statewide data analytics infrastructure would be paired with the ASO, leveraging Medicaid claims, eligibility, and provider data to facilitate care coordination across care settings and support robust population health management.
In addition to these administrative and care coordination responsibilities, the ASO would be charged with working with Medicaid providers to support movement across a continuum of value-based payment arrangements, designed to reward quality outcomes and cost efficiency. The ASO would offer a range of practice transformation technical assistance, including clinical guidelines and best practices, workflow redesign/management, risk assessment and stratification, root cause analysis and performance improvement plan development.
A transitional payment model – providing a uniform payment schedule with routine updates, and considerations for sustaining community hospitals – would replace MCO payments as a foundation. The State would then work with stakeholders to develop a value-based payment (VBP) roadmap, including a menu of VBP options built upon a set of measures in support of the State’s quality, access and efficiency goals.
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Orange City Area Health System (OCAHS) supports a new model for Medicaid that, first and foremost, meets the health needs of those it is intended for. Second, OCAHS supports a sustainable financial model that ensures quality, efficiency, and accessibility with alignment to Medicare and other commercial carrier goals of data, transparency, and accountability. Finally, OCAHS supports a model that rewards providers for innovation in meeting the needs of those we serve, which ultimately is what is best for all of Iowa.
We believe the IHA proposed “Third Way” is one such model with this potential. We are open to any other model that accomplishes similar goals and outcomes.
[/et_pb_text][/et_pb_column][et_pb_column type=”1_3″][et_pb_button _builder_version=”3.0.92″ button_text=”Overview of Iowa Medicaid Managed Care” button_url=”https://www.youtube.com/watch?v=z4vDFGhq3l0&feature=youtu.be” url_new_window=”on” background_layout=”light” custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#e02b20″ button_font=”|700|||||||” button_icon=”%%40%%” button_icon_color=”#ffffff” button_icon_placement=”right” button_on_hover=”off” custom_padding=”12px|12px|12px|12px” box_shadow_style=”preset2″ /][et_pb_button _builder_version=”3.0.92″ button_text=”Shealyn’s Medicaid Story” button_url=”https://www.youtube.com/watch?v=Ss_SlKvzExE&feature=youtu.be” url_new_window=”on” background_layout=”light” custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#e09900″ button_font=”|700|on||||||” button_icon=”%%221%%” button_icon_color=”#ffffff” button_icon_placement=”right” button_on_hover=”off” custom_padding=”12px|12px|12px|12px” box_shadow_style=”preset2″ /][et_pb_button _builder_version=”3.0.92″ button_text=”Kyle’s Medicaid Story” button_url=”https://www.youtube.com/watch?v=EBJsEHdwnQc&feature=youtu.be” url_new_window=”on” background_layout=”light” custom_button=”on” button_text_color=”#ffffff” button_bg_color=”#e09900″ button_font=”|700|||||||” button_icon=”%%222%%” button_icon_color=”#ffffff” button_icon_placement=”right” button_on_hover=”off” custom_padding=”12px|12px|12px|12px” box_shadow_style=”preset2″ /][/et_pb_column][/et_pb_row][/et_pb_section][et_pb_section bb_built=”1″][et_pb_row][et_pb_column type=”4_4″][et_pb_text _builder_version=”3.0.92″ background_layout=”light”]
$1.4 Million in Uncompensated Care and Health Care Services Given Annually
Orange City Area Health System
provides over $1.4 million in community benefits to the northwest Iowa region, according to a recently completed assessment of those programs and services. That amount, based on 2017 figures, includes $685,000 in uncompensated care and $745,000 in free or discounted community benefits that Orange City Area Health System specifically implemented to help the region’s residents.
Community benefits are activities designed to improve health status and increase access to health care. Along with uncompensated care (which includes both charity care and bad debt), community benefits include such services and programs as health screenings, support groups, counseling, immunizations, nutritional services, and transportation programs.
The results for Orange City Area Health System are included in a statewide report by the Iowa Hospital Association (IHA) that shows Iowa hospitals provided community benefits in 2017 valued at more than $880 million, including more than $224 million in charity care.
“We embrace the role expected of us in providing benefit to the region we serve that is beyond providing direct health care,” commented Marty Guthmiller, CEO for Orange City Area Health System and chair-elect of IHA. “It is a critical element of all Iowa hospitals.”
The programs and services accounted for in the survey were implemented in direct response to the needs of individual communities as well as entire counties and regions. Many of these programs and services simply would not exist without hospital support and leadership, said IHA President and CEO Kirk Norris.
Uncompensated care (which is made up of both charity care and bad debt) also plays a role in overall community benefit for services provided by hospitals. Total uncompensated care in 2017 was valued at $502 million. The survey also showed total Medicare and Medicaid losses (at cost) of $226 million.
Charity care in Iowa hospitals has declined precipitously since implementation of the Affordable Care Act (ACA), including Iowa’s expansion of the Medicaid program. Recent efforts in Congress to repeal the ACA and roll back expansion would not only leave tens of thousands of Iowans without insurance, but would financially endanger hospitals across the state, which is why IHA has strenuously opposed such legislation.
Iowa hospitals, which employ more than 74,000 people, continue implement strategies that increase value to their patients and communities by offering high-quality care to individuals, addressing the health needs of communities and implementing process improvements that bend the cost curve. By seeking out ways to raise quality, reduce waste and increase safety, Iowa hospitals have become value leaders, as shown in multiple studies by the Dartmouth Atlas of Health Care, the Commonwealth Fund and others.
These efforts, along with IHA’s ongoing advocacy to create fairer payment methodologies from Medicare and Medicaid, help ensure the financial stability of hospitals, making it possible for them to provide the services and programs most needed by their communities.
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-by Nick Adams, PT, Orange City Area Physical & Occupational Therapy
Do you or someone you know struggle with balance? Have you or a loved one suffered from a fall recently? According to the National Council on Aging and the U.S. Centers for Disease Control and Prevention, 1 in 4 Americans aged 65 and older falls each year, and every 11 seconds an older adult is treated in the emergency room for a fall. Not every fall causes an injury, but injuries and deaths from falls have continued to rise. Along with potential physical harm from a fall, it is very common for someone who has fallen to become depressed, anxious, and isolated. Falls and poor balance can instill a fear of movement, which can lead to being afraid to go out in public, run to the grocery store, attend church, and many perform many other activities.
The good news is that by having an understanding of falls and preventative measures, working on living a healthy lifestyle, and challenging your balance system to improve, you can help manage your fall risk. Hospitals throughout the nation are working to promote fall risk awareness and implementing balance and fall prevention programs. From medication management and blood pressure screens to body movement and balance screens, preventing falls has become a major goal for healthcare providers. In physical therapy specifically, we can work on improving your strength and proprioception, as well as help with issues with your vestibular system which may be affecting your balance.
Our bodies work to keep our balance when three systems work together to give feedback to your brain. The first is your vision. When you have your eyes open, your visual system is working to tell your brain how your body is positioned. This is why it’s much harder to balance with your eyes closed, or in a poorly lit room. The second system working is your vestibular system. This is a sensory system located in your inner ears that provide your brain with information about your head position and head motion. The third is your proprioception, which is your body’s ability to sense movement and body position. When you are standing, there are many receptors throughout your body, particularly in your feet and ankles which are constantly working to keep you upright. These three systems are continually taking in information to the brain, and your body makes corrections from all of this information to keep you upright.
September 22, 2018 is Iowa Falls Prevention Awareness Day, and our hope is that we can continue to improve awareness on fall risk and balance. If you have more questions about balance and fall prevention, or if you know someone who may benefit from a balance and fall screen, feel free to reach out to your doctor or physical therapist. Many falls can be prevented, and by making several changes in your daily life, you can lower your chances of falling.
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