Payment Reform

Payment reform to support delivery system transformation is aligned across the Medicaid MCOs as it is embedded into the state’s managed care contracting design. While ACO payments flow from the MCOs, a driving measure of quality scoring (the VIS) is calculated through the state and is one of the factors upon which performance related payments are made. Engaging in risk based contracts with ACOs allows the MCOs to shift some care coordination responsibilities to ACOs.

Iowa will further improve alignment in Medicaid VBP with the Medicare QPP. This will be accomplished through development of a glide path to collect and incorporate clinical quality measures linked to payment during 2017 and 2018. This will enable the 2019 VBP program to meet the A-APM requirements set by MACRA legislation
Iowa is committed to developing VBP strategies that align payers across the state, ensuring SIM activities have the greatest reach and improve care for all Iowans.  Building off the LAN key principles of APM development, Iowa will seek guidance from the Healthcare Innovation and Visioning Roundtable to ensure our programs are advancing statewide strategies for sustainable health by fostering common agreement around: 
  • Technical Assistance to the Delivery System 
  • Health IT Enhancements 
  • Accountable Communities 
  • Empower Patients to be Partners 
  • Fiscal Models 
  • Payment Models linked to Quality 
A primary goal of the SIM Grant is to increase participation within VBP arrangements (number of providers and number of covered lives). An additional goal is to increase the intensity (increase financial risk and reporting of quality) of those VBP contracts in Iowa to align with MACRA by offering Other Payer Advanced APM models to providers by 2019.  
The Medicaid Quality Steering committee looks at quality across Medicaid programs in an effort to align initiatives and improve health outcomes for the Medicaid members. Core functions of this group include: 
  • Recommend measures and provide ongoing monitoring of dashboard and key performance indicators. 
  • Review and revise Quality Strategy Plan for Medicaid Managed Care Program 
  • Review MCO performance improvement projects and make recommendations for enhancements 
Iowa Medicaid has aligned its quality measurement tool with Iowa’s largest commercial payer, Wellmark. The Value Index Score (VIS), consists of 16 measures across 6 domains, risk adjusted and rolled into a composite score based exclusively on claims data. The VIS incorporates 12 months of claims data, creates a longitudinal record for each member and attributes each member to a PCP.  Medicaid is in the process of incorporating the MCO encounter data to begin producing a monthly dashboard for the MCOs and for contracted ACO providers to inform quality in VBP programs that are linked to payments.
To achieve A-APM model in Iowa, the collection of clinical quality measures (in addition to the administrative measures from VIS), is a new component of the definition of quality for Iowa. During AY3 the state will implement activities that identify infrastructure and quality measures that are comparable to MIPS to be used in an A-APM model to support future programs within Iowa.

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