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 There are two main legislative requirements in Iowa to advance medical homes:

  1. Iowa’s 2008 Health Care Reform Act (House File 2539) charged the Iowa Department of Public Health with convening a Medical Home System Advisory Council to put forward recommendations for implementing a statewide patient-centered medical home (PCMH) system. The stated purpose of a patient-centered medical home is to provide for the “coordination and integration of care, focused on prevention, wellness, and chronic care management, using a whole person orientation through a provider-directed medical practice.” The program is to begin with Medicaid children.
  2. The state must convert IowaCare – a Medicaid-administered program for low-income childless adults implemented under the authority of an 1115 waiver – from a hospital-based safety net to a FQHC-based medical home model
For the IowaCare project, Iowa will use recognition by NCQA or another national body as their formal recognition process. Providers will be able to choose which organization’s process they wish to use.  The program launched with two FQHCs in October 2010. The program is to be expanded throughout the state. The Iowa Healthcare Collaborative (IHC), a non-profit group devoted to QI statewide, will assist with practice transformation and provider education.  Plans for the Medicaid children’s pilot are less defined.
 
Immediate targeted populations: Poor single adults and Medicaid children. Eventual targeted population: All Iowans.
 

Last updated: December 2010

Forming Partnerships

The Medical Home System Advisory Council (MHSAC) is made up of legislators and a variety of stakeholders including Medicaid, the AAFP, AAP, the physician assistant association, the osteopathic society, the nursing association, the chiropractic society, the medical society, the dental association, consumer groups, and the PCA. MHSAC is supported by 1.5 full-time staff within the Iowa Department of Public Health (IDPH) and has published two issue briefs to educate policymakers and stakeholders in Iowa about issues regarding the PCMH. Additional information, including meeting minutes and issue briefs, may be found on the MHSAC webpage. 

In addition to this work, the state has engaged several payers and state agencies in the development of its medical home work. The University of Iowa and the Child and Family Policy Center have also been at the table.
Defining & Recognizing a Medical Home

Definition: According to Iowa’s 2008 Health Care Reform Act (House File 2539), a patient-centered medical home means an “approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient’s family; utilizes the partnership to access all medical and nonmedical health-related services needed by the patient and the patient's family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the characteristics specified in section 135.158.” (Section 135.158 identifies the following characteristics: personal provider, provider-directed medical practice, whole person orientation, coordination and integration of care, quality and safety, enhanced access to health care, and appropriate payment.)

Recognition: For the IowaCare project, Iowa will use recognition by NCQA or another national body as their formal recognition process. Providers will be able to choose which organization’s process they wish to use.  For more information, see this April 2010 white paper.
Aligning Reimbursement & Purchasing

For the IowaCare program, participating health centers will receive PMPM payments for care coordination ranging from $1.50-$3.50, depending on medical home level. Performance-based PMPM payments ranging from $1.00-$1.50 will be made as well.

Iowa also plans to begin paying primary care providers for remote consultations with hospital-based specialist in order to support transition planning for hospitalized patients. This strategy is intended to support care coordination in remote areas of the state where face-to-face consultations between hospitals and medical home practices are impractical.
Supporting Practices The Iowa Healthcare Collaborative (IHC), a non-profit organization dedicated to educating and equipping health care providers across Iowa, will assist providers in obtaining NCQA recognition. Participation in the Iowa Healthcare Collaborative Medical Home Learning Community is a condition of receiving medical home recognition.
Measuring Results

IowaCare will draw on clinical information from patient registries and provider records to evaluate progress in several key areas of interest including:

  • Reduction in unjustified variation of utilization and expenditure;
  • Improvement of safety, timeliness, effectiveness, and efficiency;
  • Increased patient participation in decision making;
  • Increased access to evidence-based care in underserved areas; and
  • Medicaid and Medicare cost containment