Keith Mueller, Gerhard Hartman Professor and head of the Department of Health Management and Policy in the College of Public Health, was one of six University of Iowa faculty members honored with the 2016 Board of Regents Award for Faculty Excellence. The UI’s annual Faculty and Staff Awards Banquet was held on Oct. 8, sponsored by the Office of the Provost and the Office of the Vice President for Human Resources.
Mueller is one of the nation’s leading experts in rural health services and policy. His service to rural communities includes sitting on the board of the Iowa Rural Health Association (of which he was president in 2015) and working with the Iowa Hospital Association to provide guidance to Iowa hospitals. He has served as president of the National Rural Health Association and is a member of the National Advisory Committee on Rural Health and Human Services.
As director (since 2000) of the Rural Policy Research Institute Center for Rural Health Policy Analysis, he has increased the center’s funding portfolio to create additional research opportunities for faculty, staff, and students. Under his leadership, the department has grown in numbers, reinforced its commitment to the success of junior faculty members, and implemented two new degree programs.
View a full listing of 2016 UI faculty and staff awards.
Premiums for health plans offered through insurance marketplaces are expected to increase substantially in the coming year, but a new report co-authored by a University of Iowa health policy researcher shows that rural areas of the United States already face higher premiums compared to urban places, and the gap appears to be widening.
Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health, joined colleagues from the Brown School at Washington University in St. Louis in a study of data on 2016 premiums from the Centers for Medicare & Medicaid Services, as well as information compiled from state-based marketplaces. They found that premiums had increased disproportionately in rural areas. The data differed from previous years, when urban and rural premium increases did not show a consistent pattern.
The researchers cautioned that their study focused only on premiums without accounting for subsidies and other cost-sharing adjustments that reduce the actual cost of insurance coverage for the majority of consumers.
The researchers found average adjusted premiums in rural counties are higher than in urban counties, with a widening gap in 2016 for both federally operated marketplaces and state-based marketplaces. In 2016, rural averages in the federally operated marketplaces were $306, compared to urban averages of $287. In the state-based marketplaces, rural averages were $285, compared to urban averages of $245.
Health insurance marketplaces, also known as exchanges, were established under the federal Affordable Care Act (ACA) as a resource for individuals, families, and small businesses to access, compare, and purchase health insurance plans. The exchanges are intended to restrain premium increases by encouraging competition among health plans.
The researchers also observed a disparity between rural and urban areas in terms of the number of insurance companies participating in exchanges. In 2016, urban counties had an average of 4.2 firms participating, while rural counties had an average of 3.2 firms participating.
“If premiums are higher in areas with less competition among firms, and less competition is occurring in rural areas, then there is a differential in premiums that is affecting people based upon where they live,” the researchers noted.
The report was conducted by the RUPRI Center for Rural Health Policy Analysis, based in the University of Iowa College of Public Health. This study was supported by the Federal Office of Rural Health Policy in the Health Resources and Services Administration, under the U.S. Department of Health and Human Services. The full report is available on the RUPRI website.
Under a contract with the Iowa Department of Public Health (IDPH), researchers from the UI Center for Health Policy and Research evaluated 13 health workforce development programs overseen by the state’s Bureau of Oral and Health Delivery Systems. The programs are integral to IDPH’s activities to secure high quality health care coverage throughout Iowa.
Led by Keith Mueller, Gerhard Hartman Professor and head of health management and policy, the team studied the programs’ scope and impact, and identified gaps and impediments to success. Eight of the 13 programs currently receive annual state-appropriated funds totaling $2,668,000. As part of the program evaluation, recommendations for fund-allotment to improve outcomes were made.
“We recommend that the state continue to target specific needs such as mental and dental health and fund approaches that promote recruitment and retention, including providing expanded training,” said Mueller. “IDPH administrators will continue to monitor program performance and shape future directions for developing Iowa’s health workforce, including appropriate reallocation of resources among existing programs. These programs represent the state’s response to needs of Iowans for proximate access to vital services, and ongoing evaluation will be important.”
This project was funded by IDPH and the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. The executive summary and the full report are available online:
A new research report by the Rural Policy Research Institute’s Health Panel, which includes University of Iowa faculty and is supported by research staff in the UI Department of Health Management and Policy, outlines the challenges and opportunities confronting rural providers, policymakers, and health systems as they work to implement reforms in rapidly expanding state Medicaid programs.
The report notes that efforts to reform the health care delivery system are gaining momentum among all payers and within Medicaid programs in particular, given their significance to a growing population as well as to state budgets. The report calls on policymakers to “recognize both the desirability and shortcomings of new delivery system models for rural patients and providers.”
“While both national and state policymakers shape Medicaid reform, state-level policies have the potential to encourage a broader statewide focus on population health by connecting Medicaid to other important and impactful state-level resources, like human and social support services and public health,” the report states. “In implementing policies that promote delivery system reform, it is important to consider how certain models may be capable of either promoting access for rural populations or diminishing it.”
According to the report, broadened eligibility under the federal Affordable Care Act (ACA) nearly doubled the percentage of people covered by Medicaid programs — from 10.4 percent of the U.S. population in 2000 to 19.5 percent in 2014. As of January 2016, more than 72 million people nationwide were enrolled in Medicaid.
The significance of state Medicaid programs is even greater in rural areas where, as of 2014, 22 percent of residents were enrolled. Medicaid has surpassed Medicare as the largest source of public health coverage in rural areas, and is second in coverage only to employer-sponsored insurance plans. The program is also a crucial source of provider payments in rural communities.
The report identifies six recommendations for rural policymakers, providers, and communities. The recommendations are:
- Promote integrated and comprehensive primary care delivery.
- Promote integrated and comprehensive care across the health care continuum.
- Promote accountability for the health of the Medicaid population in rural communities.
- Promote measures, reporting standards, and payment approaches relevant to rural providers.
- Promote payment designs that recognize the nature and circumstances of rural providers and systems.
- Provide technical assistance to rural providers during the Medicaid transition to value-based payment.
The report was authored by the RUPRI Health Panel, which is chaired by Dr. Keith Mueller, professor and head of health management and policy at the University of Iowa College of Public Health. The work was supported by the Leona M. and Harry B. Helmsley Charitable Trust. The full report is available at the RUPRI website.