Iowa Rural Health Association Rebalancing Healthcare in the Heartland

Earlier this month, a handful of TSC staffers traveled to Des Moines for the “Rebalancing Health Care in the Heartland” event hosted by the Iowa Rural Health Association and the University of Iowa’s Health Sciences Policy Council. This year’s conference, “Transforming Health Care During Uncertain Times,” was an opportunity for thought leaders and policymakers to come together to discuss how we can meet Iowa’s health care needs, especially for individuals in rural communities. Major topics of consideration included uncertainty in current federal healthcare policy, the state of healthcare in Iowa, and the opioid epidemic.

Federal and State Legislative Concerns
The day opened with an update on Iowa’s insurance marketplace from Iowa Insurance Division Commissioner Doug Ommen. This was a timely discussion, as Iowa’s individual marketplace is currently in open enrollment. Ommen described the state’s attempt to improve the marketplace through the Affordable Care Act (ACA), which is designed for those who lack health insurance coverage through an employer or government program. The state’s proposal, the Iowa Stopgap Measure, attempted to improve the marketplace for 2018; however the measure was withdrawn at the end of October. As a result, Medica is left as the only provider in the state offering individual plans.

The keynote speech was a congressional update from the nation’s capital delivered by Ashley Ridlon, a senior manager at the Bipartisan Policy Center. She warned of significant legislative uncertainty during an unprecedented year and with major items pending, which makes it difficult to predict what might happen. Ridlon noted several factors that could influence future policy:

  • A bipartisan committee in the Senate, HELP, has proposed several changes to the ACA, but the effort has been stalled.
  • The tax reform could affect the individual mandate for health insurance.
  • A Health and Human Services Secretary has yet to be appointed.
  • Pending items such as Child Health Insurance Plan (CHIP) and funding for federally qualified health centers (FQHC) have recently expired. Iowa has provided the funds to keep hawk-I (Iowa’s version of CHIP) running until March.

We should expect to see opportunities for telehealth, such as a reduction in limiting regulations and telemedicine billing codes.

In the afternoon, six Iowa Democratic and Republican Gubernatorial Candidates took the stage to share their perspective on the health care concerns of the state. At the top of the list are Medicaid managed care, mental health and opioid issues.

Perspectives on the Opioid Crisis
James Ray, PharmD, CPE, clinical associate professor at UI College of Pharmacy, presented a lesser-known perspective on the opioid crisis. He explored how a high incidence of chronic pain and provider prescribing has contributed to opioid abuse. In light of the epidemic, Ray focused on the importance of correct opioid usage for palliative care. Following his presentation was a panel of individuals on the front lines of the epidemic, Malissa Sprenger, MS, IAADC, coordinator of Mercy Turning Point Treatment Center; Barb St. Marie, PhD, ANP-BC, ACHN, assistant professor at UI College of Nursing; and Ryan Carnahan, PharmD, MS, associate professor at UI College of Public Health.

A few major themes emerged from the discussion of opioids. Patients would benefit from counseling on the safety of prescriptions, including pain management and safe storage and disposal of medications. Removing barriers to Iowa’s Prescription Monitoring Program to allow providers to accurately track patient use of controlled substances would strengthen surveillance capacity and ultimately improve the quality of patient care. Another consideration is to ensure insurance coverage for medication-assisted treatment (MAT) and evidence-based behavioral interventions. Currently, there is no law requiring Medicaid coverage of MAT, and access to such treatment is difficult, especially in rural areas. Finally, physicians would greatly benefit from further education around pain management and prescribing.

The Signal Center is actively evaluating how digital health tools can positively contribute to tackling the opioid crisis. We are in conversation with Iowa government officials to discuss strategies for reaching individuals, especially in rural areas. Furthermore, the grant funded eHealth Extension Network provides a platform where rural providers can participate in pharmacology Grand Rounds education to learn more about managing patient pain and increase use of the Prescription Monitoring Program. We are actively working to utilize this telehealth connection to extend education across the state.

Major Takeaways
The event underscored the importance of working across disciplines to solve healthcare problems and continue to communicate with policymakers in Iowa. At TSC, we know the value of different perspectives and continue to invite physicians, legislators, pharmacists, nurses, and others involved in healthcare to the table to improve the health of all Iowans.