135.161 - PREVENTION AND CHRONIC CARE MANAGEMENT INITIATIVE -- ADVISORY COUNCIL.
135.161 PREVENTION AND CHRONIC CARE MANAGEMENT
INITIATIVE -- ADVISORY COUNCIL.
1. The director, in collaboration with the prevention and chronic
care management advisory council, shall develop a state initiative
for prevention and chronic care management. The state initiative
consists of the state's plan for developing a chronic care
organizational structure for prevention and chronic care management,
including coordinating the efforts of health care professionals and
chronic care resources to promote the health of residents and the
prevention and management of chronic conditions, developing and
implementing arrangements for delivering prevention services and
chronic care management, developing significant patient self-care
efforts, providing systemic support for the health care
professional-patient relationship and options for channeling chronic
care resources and support to health care professionals, providing
for community development and outreach and education efforts, and
coordinating information technology initiatives with the chronic care
information system.
2. The director may accept grants and donations and shall apply
for any federal, state, or private grants available to fund the
initiative. Any grants or donations received shall be placed in a
separate fund in the state treasury and used exclusively for the
initiative or as federal law directs.
3. a. The director shall establish and convene an advisory
council to provide technical assistance to the director in developing
a state initiative that integrates evidence-based prevention and
chronic care management strategies into the public and private health
care systems, including the medical home system. Public members of
the advisory council shall receive their actual and necessary
expenses incurred in the performance of their duties and may be
eligible to receive compensation as provided in section 7E.6.
b. The advisory council shall elicit input from a variety of
health care professionals, health care professional organizations,
community and nonprofit groups, insurers, consumers, businesses,
school districts, and state and local governments in developing the
advisory council's recommendations.
c. The advisory council shall submit initial recommendations
to the director for the state initiative for prevention and chronic
care management no later than July 1, 2009. The recommendations
shall address all of the following:
(1) The recommended organizational structure for integrating
prevention and chronic care management into the private and public
health care systems. The organizational structure recommended shall
align with the organizational structure established for the medical
home system developed pursuant to division XXII. The advisory
council shall also review existing prevention and chronic care
management strategies used in the health insurance market and in
private and public programs and recommend ways to expand the use of
such strategies throughout the health insurance market and in the
private and public health care systems.
(2) A process for identifying leading health care professionals
and existing prevention and chronic care management programs in the
state, and coordinating care among these health care professionals
and programs.
(3) A prioritization of the chronic conditions for which
prevention and chronic care management services should be provided,
taking into consideration the prevalence of specific chronic
conditions and the factors that may lead to the development of
chronic conditions; the fiscal impact to state health care programs
of providing care for the chronic conditions of eligible individuals;
the availability of workable, evidence-based approaches to chronic
care for the chronic condition; and public input into the selection
process. The advisory council shall initially develop consensus
guidelines to address the two chronic conditions identified as having
the highest priority and shall also specify a timeline for inclusion
of additional specific chronic conditions in the initiative.
(4) A method to involve health care professionals in identifying
eligible patients for prevention and chronic care management
services, which includes but is not limited to the use of a health
risk assessment.
(5) The methods for increasing communication between health care
professionals and patients, including patient education, patient
self-management, and patient follow-up plans.
(6) The educational, wellness, and clinical management protocols
and tools to be used by health care professionals, including
management guideline materials for health care delivery.
(7) The use and development of process and outcome measures and
benchmarks, aligned to the greatest extent possible with existing
measures and benchmarks such as the "best in class" estimates
utilized in the national healthcare quality report of the agency for
health care research and quality of the United States department of
health and human services, to provide performance feedback for health
care professionals and information on the quality of health care,
including patient satisfaction and health status outcomes.
(8) Payment methodologies to align reimbursements and create
financial incentives and rewards for health care professionals to
utilize prevention services, establish management systems for chronic
conditions, improve health outcomes, and improve the quality of
health care, including case management fees, payment for technical
support and data entry associated with patient registries, and the
cost of staff coordination within a medical practice.
(9) Methods to involve public and private groups, health care
professionals, insurers, third-party administrators, associations,
community and consumer groups, and other entities to facilitate and
sustain the initiative.
(10) Alignment of any chronic care information system or other
information technology needs with other health care information
technology initiatives.
(11) Involvement of appropriate health resources and public
health and outcomes researchers to develop and implement a sound
basis for collecting data and evaluating the clinical, social, and
economic impact of the initiative, including a determination of the
impact on expenditures and prevalence and control of chronic
conditions.
(12) Elements of a marketing campaign that provides for public
outreach and consumer education in promoting prevention and chronic
care management strategies among health care professionals, health
insurers, and the public.
(13) A method to periodically determine the percentage of health
care professionals who are participating, the success of the
empowerment-of-patients approach, and any results of health outcomes
of the patients participating.
(14) A means of collaborating with the health professional
licensing boards pursuant to chapter 147 to review prevention and
chronic care management education provided to licensees, as
appropriate, and recommendations regarding education resources and
curricula for integration into existing and new education and
training programs.
4. Following submission of initial recommendations to the
director for the state initiative for prevention and chronic care
management by the advisory council, the director shall submit the
state initiative to the board for approval. Subject to approval of
the state initiative by the board, the department shall initially
implement the state initiative among the population of eligible
individuals. Following initial implementation, the director shall
work with the department of human services, insurers, health care
professional organizations, and consumers in implementing the
initiative beyond the population of eligible individuals as an
integral part of the health care delivery system in the state. The
advisory council shall continue to review and make recommendations to
the director regarding improvements to the initiative. Any
recommendations are subject to approval by the board. Section History: Recent Form
2008 Acts, ch 1188, §51
Referred to in § 135.162, 136.3