Iowa Medicaid Enterprise

Commitment Statement:

Value Based Purchasing efforts in Iowa began in the private sector and Medicare in 2012 and in Medicaid in 2014. Currently Medicaid is working with newly implemented MCOs to develop VBP models that qualify by 2018 for payment Category 3 APMs. Through the SIM initiative and beyond, Iowa is committed to move more healthcare spending into Categories 3 and 4.

Iowa will use the SIM grant to implement and evaluate a sustainable health care delivery and payment system that will improve population health, improve patient care, and bend health care cost trends. The SIM Test aligns Iowa payers in payment reform that focuses on value; equips Iowa providers with tools to perform in value based, population focused models; and aligns and integrates public health strategies into how health care is delivered. Together, these approaches ensure a robust, statewide transformation to achieve Iowa’s SIM vision, “Transforming Health Care to Improve the Health of Iowans.” Iowa aims to:

– Reduce the rates of preventable events (i.e. Emergency Department (ED) visits and inpatient admissions) for individuals in a value-based purchasing arrangement by 20% by the end of the SIM test grant
– Increase the number of providers participating in Value-Based Purchasing (VBP) 50% and establish a decreased trend in Total Cost of Care (TCOC) by the end of the SIM test grant
– Improve the health of its population by the end of the SIM test grant in three of the SIM focus areas:
– Tobacco Use: Increase quit attempt rate by 5.1%
– Obesity: Decrease prevalence rate by 2.9%
– Diabetes: Increase A1C test rate for diabetics by 4.1%


Iowa Medicaid Enterprise