Managed Care | Year One The Iowa Medicaid program sees successes, and continued challenges

It’s been one year since the state handed over its Medicaid program with nearly 600,000 poor and disabled Iowans to three private insurance companies.

What a year it’s been.

Providers ran into billing issues, complaining that the insurers were not paying them properly or on time. AmeriHealth Caritas Iowa, Amerigroup Iowa and UnitedHealthcare of the River Valley all lost more than $100 million during their first year of operation.

And most recently, the state of Iowa has opted to enter into a risk corridor agreement — in which the government steps in to help protect insurers from unexpectedly high losses by paying the difference if an insurer spends more in medical care than it collects in revenue. The price tag for the state is $10 million, with another $225 million from the federal government.

“The first year has been spent trying to resolve mechanical issues — prior authorizations, payment and contract issues. We could do well to spend more time next year helping the MCOs understand the services we provide in the community.”

– Dan Strellner

President, Abbe Inc.


It hasn’t been all negative — 238,000 Medicaid beneficiaries have received a health risk assessment, which gets them targeted care coordination earlier; the state has worked to put out quarterly reports showing if MCOs are meeting previously agreed upon benchmarks; and the state reports that hospital admissions and readmissions are down for the Medicaid population.

The Gazette spoke with a number of different stakeholders about the first year of Medicaid managed care as well as their hopes for year No. 2.

The three managed-care organizations either declined request for an interview or did not respond to The Gazette’s request.

Photo from 2006 in Cedar Rapids leads to worldwide recognition of new cloud

A photo taken nearly 11 years ago in Cedar Rapids has led to the worldwide recognition of a previously unclassified type of cloud.

“I feel very privileged to be a part of all that,” said Waterloo photographer Jane Wiggins, who on June 20, 2006, captured images of a cloud formation that since has been christened “asperitas” and recently included in the World Meteorological Organization’s International Cloud Atlas.

While she specializes in weddings and portraits, Wiggins has a photographer’s eye for dramatic images and instantly recognized the appeal of the skyscape outside the 11th-floor window of the U.S. Bank building in downtown Cedar Rapids.

Wiggins, who was not on a photo assignment but had her camera with her, said she opened a window to eliminate the possibility of unwanted reflections and “took four or five photos from different angles of the amazing clouds over the Quaker Oats plant.”

Wiggins described the weather that day as calm. “It was the morning after a rain, and there was no storm at all” associated with the wave clouds, she said.

Though Wiggins had no immediate plans for the photo, she shared it with associates, one of whom suggested she submit it to the Cloud Appreciation Society based in Somerton, England.

Recognizing the distinctive character of the cloud, the society’s founder, Gavin Pretor-Pinney, proposed a formal Latin name, Undulatus asperatus (later changed to asperitas), and led an ultimately successful 10-year campaign for its recognition by the World Meteorological Organization.

“Ever since we first noticed distinctive turbulent waves of cloud back in 2006 in images sent from Cedar Rapids, Iowa, US, we have argued that this formation did not easily fit within the existing naming system. So we are very pleased that now, almost 10 years later, Asperitas is finally being accepted as an official classification by the World Meteorological Organization,” the Cloud Appreciation Society wrote in a recent post on its website.

Given that most landscapes include as much sky as land, “clouds add interest and drama to a photo, especially of sunrises and sunsets,” said Wiggins, who has long been fascinated by clouds and storms and often sits outside watching the approach of a storm “until I absolutely have to go inside.”

Of all her photos, Wiggins said her asperitas photo has been by far the most widely published and viewed, with publishers including the Cloud Appreciation Society, the National Geographic Society, the British Broadcasting Corporation, CBS News and USA Today.

KCRG-TV9 meteorologist Kaj O’Mara recalls seeing the cloud that Wiggins photographed in 2006.

“Oh yeah, that was a fun one, a pretty rare sight,” he said.

Asperitas clouds consist of moisture sandwiched between layers of stable air and present no strong indication of an impending storm, O’Mara said.

“They look more ominous than they really are,” he said.

While clouds play an important role in predicting the weather, O’Mara said the station’s weather crew does not keep a cloud atlas as a reference.

Meteorologists, he said, rely on clouds in helping to predict daily high and low temperatures and the arrival of storms. In doing so, the three basic cloud types — cumulus, stratus and cirrus — and their combinations are typically sufficient, he said.

The proliferation and portability of digital cameras during the past 20 years has resulted in a profusion of cloud and storm photos.

When rare and dramatic clouds appear, “social media blows up,” O’Mara said.

Such photos can help verify storm reports and document damage, but blog rumors, especially of impending blizzards, can spread misinformation and fuel needless anxiety, he said.

What They’re Thinking: Marion’s new police chief starting to put touches on force

MARION — It has been an active first few months for new Marion Police Chief Joseph McHale.

Since coming in December from the Kansas City, Mo. Police Department, where he spent 25 years, McHale has been keeping busy. He has already begun the process of applying tactics that proved successful in Kansas City to Marion, such as studying social networks in the community to better combat crime.

The Marion Police Department employs 45 officers and 12 civilian employees, according to the city’s website. McHale took over from Harry Daugherty, who retired in June 2016 after 20 years as chief.

More than three months into his new role, McHale said he still is settling in and putting his personal touches on the police department.

His take on the differences between police work in Kansas City and Marion:

“When it comes to policing, whether it’s an agency that has 2,000 people — like Kansas City — or 55 (people) like Marion — it’s the same. You’re dealing with the same problems. It’s scale.”

On changes he’d like to bring to the Marion department:

“I have to set up the police department for growth. Not that they have been doing anything bad here. For example, they never had a commanding officer that worked past 4 p.m. I had to adjust the command structure to provide oversight and supervision. I promoted a gentleman. … He’s going to be the first night commander for the Marion Police Department. That was a big change.”

On creating a “power shift” for the police department:

“We don’t need the same amount of staff at 5 a.m. that we do at 5 p.m. I decided to do a power shift. I put officers on a schedule that’s Wednesday through Saturday. They’ll work from 6 p.m. to 4 a.m.

“I also put a supervisor on that same power shift. That way, I can have supervision and at least two officers out during our shift change at 10 p.m. That’s a time when we’re vulnerable.”

On Marion’s reputation and educating the public:

“We do ourselves a little bit of a disservice when we say we’re one of the safest communities in Iowa. We are. But, we also need to educate our citizens that there is crime and it does happen.”

On upcoming events to build relationships with the community:

“In May, I’m going to host a group from Kansas City called Mothers in Charge. They’re a group of women that have lost children to homicide. They helped us bridge the gap in Kansas City between the police and the community.”

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EICC summer course enrollment begins April 10

Eastern Iowa Community Colleges (EICC) is offering enrollment for summer classes beginning Monday, April 10. The college offers both four- and eight-week sessions beginning Tuesday, May 30, and a second four-week session, beginning Monday, June 26. In addition, there is…