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