Iowa Department of Human Services Releases First Medicaid Modernization Quarterly Report
(DES MOINES) – Today, Gov. Terry E. Branstad and Lt. Gov. Kim Reynolds commend the Iowa Department of Human Services for releasing the first Medicaid Modernization Quarterly Report demonstrating significant outcome achievement for patients, strong consumer protections, and robust program integrity. Gov. Branstad signed every Medicaid Modernization oversight item into law from the 2015 and 2016 legislative sessions. Medicaid Modernization is delivering more accountability in our Medicaid program than ever before by tracking nearly 1,000 measurable health outcomes.
“Iowa patients and Iowa taxpayers have never had this thorough or transparent of a look and review of our Medicaid program. This report will help us improve the health of our state with our health plans demonstrating a significant focus on improving Medicaid patient health,” Governor Branstad said. “Over 22,200 extremely high-risk Medicaid patients with chronic conditions such as diabetes now have a health care coordinator and over 155,000 new Medicaid patients have taken a health risk assessment.”
Lt. Gov. Reynolds added, “We now have nearly 1,000 measurable results tracking the health outcomes of Medicaid patients that old Medicaid never did. Iowa’s Medicaid program is one of the most transparent, outcome-focused, and accountable programs in the country.”
Medicaid Modernization is a proactive, patient-centered approach to modernizing Iowa’s old Medicaid program. Patients have more choice than ever before fitting their individual needs, more access to services, and real accountability improving the health of more than 500,000 Iowans. Medicaid Modernization has delivered unprecedented transparency and results into Medicaid. Over 155,000 patient health risk assessments were conducted in the first quarter by the health plans. Managed care is working for Iowa taxpayers by stopping improper payments. Iowa’s old Medicaid fee-for-service program had an improper payment rate in 2014 of 9.9%, accounting for $318,590.017 in improper payments. All three health plans exceeded the contractual expectation that 90% of payment claims be paid within 14 days. The Medicaid Modernization Quarterly Report is a comprehensive review of key metrics focused on outcome achievement, consumer protection, and program integrity.
Medicaid Modernization April-June 2016 Quarterly Report Executive Summary
Outcome Achievement
· Patients Have Choice for the First Time: New to the Medicaid program, over 100,000 patients have actively chosen a health plan that fits their individual needs. Benefits regardless of health plan do not change from the old Medicaid program.
· New Benefit – Health Care Coordinator: Over 22,200 extremely high-risk patients with chronic conditions (e.g., diabetes, COPD, asthma) were identified by the health plans as patients who would benefit with more intensive health care management and were assigned a health care coordinator. This is a new and more comprehensive health care coordinating strategy that only the health plans can deliver. This benefit will make patients healthier.
· New Benefit - Health Risk Assessments for New Patients: Over 155,000 patient health risk assessments were conducted in the first quarter by the health plans with many more patients outreached by the health plans. Health risk assessments were not required in the old Medicaid program. Patients identifying risk factors to their health and making corrections help them live longer, healthier lives with their families and friends.
Consumer Protection
· Community-Based Case Management Ratios Exceed Expectations: Patients on home and community based waiver programs (e.g., brain injury, children with behavioral health needs, elderly, physically disabled) have a community-based case manager to conduct care coordination. All the health plans met state, federal, or contractual expectations where applicable. The old Medicaid never tracked or had an expectation for community-based case management ratios.
· 100% of Appeals and Grievances Resolved Timely: All the health plans resolved 100% of grievances and appeals timely. The old Medicaid program never had a requirement that grievances be resolved within 30 days and appeals within 45 days. This expectation met by the health plans ensures patients get timely resolution.
· Patients Receive Timely Helpline Services: When patients have questions they can contact the health plans’ member helpline. All three health plans exceeded the timeliness requirements required by their contract. Also, the state conducts “secret shopper calls” to ensure quality of those helpline services.
Program Integrity
· Plans Begin All Necessary Program Integrity Activities: Managed care is an effective tool to combat improper payments as the Federal HHS Fiscal Year 2015 Agency Report found. Iowa’s old Medicaid fee-for-service program had an improper payment rate in 2014 of 9.9%, accounting for $318,590.017 in improper payments. The national managed care improper payment rate was 0.12% in 2015. Sophisticated modern technology operated by the health plans is the main strategy to eliminating fraud, waste, and abuse in the Medicaid program as the federal government under President Obama has established.
· Providers Receive Timely Helpline Services: When providers have questions they can contact the health plans’ provider helpline. All three health plans exceeded the timeliness requirements required by their contract. Also, the state conducts “secret shopper calls” to ensure quality of those helpline services.
· Health Plans Exceed Claims Requirements: All three health plans exceeded the contractual expectation that 90% of payment claims be paid within 14 days. Old Medicaid never had an expectation for payment claims. The average payment claim under Medicaid Modernization is paid under 9 days. This is on par with the old Medicaid program paying an average of 7-10 days.
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