Eastern Iowa weighing the effect of IowaCare's end

Transition, so far, has gone ‘smoothly,' official says

Dr. Brad Archer (center) and Deanna Glass (right) discuss medications with new patient Tracy Tomkins of Marion at the Mercy Health Partners clinic at Mercy Medical Center on Monday, Feb. 17, 2014, in Cedar Rapids. Tomkins had been on Iowa Care in the past but has been uninsured. Glass, who is a social worker at the clinic, will be helping Tomkins sign up for a new insurance plan. (Liz Martin/The Gazette-KCRG)
Dr. Brad Archer (center) and Deanna Glass (right) discuss medications with new patient Tracy Tomkins of Marion at the Mercy Health Partners clinic at Mercy Medical Center on Monday, Feb. 17, 2014, in Cedar Rapids. Tomkins had been on Iowa Care in the past but has been uninsured. Glass, who is a social worker at the clinic, will be helping Tomkins sign up for a new insurance plan. (Liz Martin/The Gazette-KCRG)

Tens of thousands of low-income Iowans are enrolled in Iowa’s new comprehensive health benefit program, and state officials said it’s serving as a national model for compliance with the Affordable Care Act.

But when analyzing the direct effect of Iowa’s new Health and Wellness Plan on local patients and health care providers, industry experts said it’s too soon to tell.

“We probably are just starting to realize the clinical impact,” said Brad Archer, executive medical director for MercyCare Community Physicians in Cedar Rapids. MercyCare is among the state’s health care providers who agreed to take new patients through the Health and Wellness Plan, which debuted Jan. 1.

“Not everyone rushes to the doctor in January,” Archer said. “But we will feel the clinical impact of that over the next 6 to 12 months.”

The Iowa Health and Wellness Plan replaced IowaCare, the state’s previous health care coverage program for low-income adults, when it expired Dec. 31. The new plan serves as a compromise between the governor’s Health Iowa Plan and Medicaid expansion.

It serves Iowans aged 19 to 64 with income up to and including 133 percent of the federal poverty level by providing a “comprehensive benefit package and provider network,” according to the Iowa Department of Human Services.

IowaCare was a limited benefit program with a limited provider network – patients only had a handful of health care provider options, including the University of Iowa Hospitals and Clinics in Iowa City or the Broadlawns Medical Center in Des Moines. Under the new program, members are able to choose their primary care providers from a larger network spread across the state.

So far, the transition from IowaCare to the new health and wellness plan has gone “very smoothly, especially in light of the delays many Americans have experienced at,” said Amy Lorentzen McCoy, a spokeswoman for the Department of Human Services.

More than 50,000 former IowaCare members automatically were enrolled in the new system, giving them access to more services and a choice in who provides their health care, including – in many cases – local options, McCoy said.

Including those who have signed up since, the Iowa Health and Wellness Plan through mid-February boasted a total enrollment of 67,893 – 55,034 in the wellness plan and 12,859 via the marketplace choice, according to McCoy.

Members can choose or are assigned providers, and they can make changes within a 90-day window.

Although the transitional effort has been massive, McCoy said, the state has worked hard at keeping costs low. So far, she said, the total administrative cost of the transition and ongoing support sits at $1.5 million.

Uptick in patients

The transition’s financial effect on local health care providers – both on the expense and revenue side – is evolving, according to industry experts.

For many local providers who were not part of the IowaCare network, the change means they’re seeing new patients and getting coverage for those they used to treat in the emergency department without being reimbursed.

“When they needed acute medical services, we were providing that anyway through urgent care or the emergency room,” MercyCare medical director Archer said about Mercy Medical Center in Cedar Rapids. “So this makes more clinical sense that we would be able to take care of them longitudinally.”

In preparation for the transition, Mercy polled its physicians about who would be willing to take new patients reallocated through the Iowa Health and Wellness Plan. Many agreed, including some willing to take as many as 200 additional patients, Archer said.

“Our physicians really stepped up and saw this as a community need,” Archer said. “They were able to open their practices to meet patient needs.”

Local providers, including those at Mercy, don’t yet have exact numbers on how many new patients they are seeing and what that means for the bottom line.

But Shawn Steffan, director of revenue cycle for Mercy’s hospital and physicians, said the change is “definitely a positive.”

“We took care of patients in the community through our emergent services,” she said. “So, by allowing them to go receive their regular care here, that is a positive for both sides – the patient and the system.”

With the new wider provider network, Cedar Rapids patients qualifying for the Iowa Health and Wellness Plan or Medicaid expansion have coverage options for care at Mercy or UnityPoint Health-St. Luke’s Hospital.

Jeni White, director of revenue cycle for UnityPoint Health, said Cedar Rapids-area patients who were enrolled to local providers by the state seem to have been split between the two health care providers.

If patients wanted to go to one or the other – or to continue going to the UIHC in Iowa City – White said the hospitals have worked together to enable that to happen. White said UnityPoint has seen an uptick in patients since Jan. 1, although she indicated that it’s too soon to know the patient-provider effect of the change.

“But the patients who were coming here and we were not getting paid for now will continue coming here, and now we will get reimbursed,” White said. “That’s a good thing. It’s good for the community and for its providers.”

It’s been ‘a lot of work’

The UI Hospitals and Clinics, on the other hand, has seen a drop in patient assignments following the transition, said UIHC co-chief operating officer Scott Turner. The Iowa City-based provider has been assigned about 3,400 patients through the Iowa Health and Wellness Plan – down from the more than 9,000 assignments through IowaCare.

UIHC officials have contacted those previously assigned to Iowa City through IowaCare to let them know they can continue to receive care at the hospitals and clinics. Turner said officials are working with patients receiving specialty care in Iowa City and – if they choose – helping them continue doing so through a referral process.

“If they want to continue receiving care here, we do that work for them,” Turner said.

In some cases, patients have developed a relationship with UIHC providers, and they want to continue seeing them. In other cases, patients would rather get care closer to home, said Tara Clark, assistant director of the UIHC’s Department of Social Services.

“Our whole interest is making sure they have the primary care provider they want,” Clark said. “Every patient situation is a bit different.”

Regardless of which option the patients choose, efforts to educate patients and help them through the transition has been “a lot of work,” Turner said.

UIHC staff members are contacting an average of 100 patients a day regarding the IowaCare transition, Turner said. They were making more than 200 contacts a day at one point. And then there are the enrollment fairs, including those at Coral Ridge Mall and the Iowa City Recreation Center.

“It’s been a big institutional focus,” Turner said. “We have been meeting every Monday for an hour since July planning and operationalizing all these different things.”

It’s too soon to tell what the financial effect for the UIHC will be – both in patient revenue and costs spent on education. March 31 is the deadline to choose a provider, and Turner said the hospital will know more then.

“The lion’s share of the work will happen between now and the end of March,” he said.

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