Iowa Public Health and Health Reform

Gerd ClabaughDeputy Director

Iowa Department of Public HealthNovember 17, 2011

Outline

• Components of Iowa’s current public health services system

• Building blocks of ACA relevant to Iowa health delivery system change

• Opportunities for public health delivery change in Iowa– ACO– Immunization– Community Utility

Selected Health Reform Themes

• Public accountability• Value-based Purchasing – triple aim– Better care for individuals– Better health for populations– Lower growth in expenditures

• Organizing care around the patient• Information Systems• More covered lives from among previously

uninsured

Iowa’s Current PH Delivery System

• Iowa’s PH delivery system focuses on access gaps:– Immunizations for children– Maternal and child health– Enable geographic and financial access

• Safety net• Supplement to the private care delivery

system

PH Opportunity

• PH brings skillsets that will be greatly valued under reform– Outreach– Population-based health– Community education– Use of data in driving decisionmaking

PH Realizes the Opportunity…

• Understanding PH’s value in the community• Building the business case for value• Being sophisticated about communicating PH

performance• Being a partner and leader in the local delivery

system• Looking for localized, collaborative solutions

ACA’s impact on Iowa PH

• ACO• Immunizations• Community Utility• Maternal Health

ACO needs…

• Strong primary care base which understands the primary care medical home concept

• Accessible care• Ability to collect data and report performance• Manage to total patient savings, not by payer• Engaged patients• Capability to serve all patients

Accountable for what?

• Total patient care• Population health outcomes• Patient care experiences• Cost

The Commonwealth Fund, April 2011

Public Health opportunity…

• Understanding of primary care• Practices as a medical home• Competency is delivery of care to

underinsured, a target population of ACA

Immunizations

• Medicaid – Medicaid coverage expansion for low-income

adults could result in more demand– Payment rates for physician administration of

vaccine will increase• Insurance Exchange-provided insurance will

include immunization coverage unless grandfathered

Delivery System needs…

• Cost effective methods of reaching their covered population

• Experience outreaching to previously underserved communities

• Additional capacity

Community Utility

• A resource shared by multiple community service providers or practices in order to achieve efficiencies in operation and management and improvements in quality

Ed Schor, 2011

Community Utility

• Care coordination• Health education• Information Technology• Quality improvement• Home visiting• Mental health consultation

Ed Schor, 2011

PH Opportunity

• PH positioned to serve geographic areas with outreach type efforts

• Utility model is shared by all• PH is a connector to community services

Example: Readmissions

• 13% of Medicare readmissions are avoidable - $12 billion

• CMS Innovation Center now working to connect hospitals to CBO’s to reduce readmissions for select conditions

• Emphasis in care transitions, connection to community resources out of the hospital

Conclusions

• Population health has been integrated into the ACA

• Greater levels for financial, outcomes, and access accountability will exist for all stakeholders

• Understanding current performance and best practices will be important to success

• Best practices deployed in the community will drive improved outcomes

References• HIGH PERFORMANCE ACCOUNTABLE CARE: BUILDING ON SUCCESS AND LEARNING FROM EXPERIENCE, Stuart Guterman,

Stephen C. Schoenbaum, Karen Davis, Cathy Schoen,Anne-Marie J. Audet, Kristof Stremikis, and Mark A. Zezza, April 2011, The Commonwealth Fund, http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2011/Apr/1494_Guterman_high_performance_accountable_care_v3.pdf

• THE AFFORDABLE CARE ACT: U.S. Vaccine Policy and Practice, Alexandra M. Stewart, Orriel L. Richardson, Marisa A. Cox, Katherine Hayes, Sara Rosenbaum, Fall, 2010. George Washington University Medical Center, http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_2A5EEA21-5056-9D20-3D060D0C87B4585D.pdf

• Creating Shared Resources to Improve Child Health & Well-Being in Communities, Edward L. Schor, MD, Senior Vice President for Programs and Partnerships, The Lucile Packard Foundation for Children’s Health, Oct 12, 2011, http://www.amchp.org/Advocacy/health-reform/Documents/10-12-2011WebinarSlides%20(2).pdf