A New Roadmap for Louisiana

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A New Roadmapfor LouisianasHealth Care
Delivery System
A New Roadmapfor LouisianasHealth Care
Delivery System
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Kim M. Boyle
Panelists Fred P. Cerise, M.D.,
M.P.H. Secretary, LA DHH Donald R.
Smithburg Executive VP, LSU System CEO, LSU
Health Care Services Div.
Panel Moderator
Kim M. Boyle
Phelps Dunbar, L.L.P.
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Health Care Redesign in Louisiana
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Why A Collaborative?
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(No Transcript)
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Louisiana Health Care Redesign Collaborative

• Created by HCR 127
• Purpose was to advise DHH in the development of a
  blueprint for redesign of the health care system
• Focus was on the hurricane-affected parishes of
  the Orleans Region area of the state
• Charged was to build upon the goals set forth by
  the Governors Health Care Reform Panel

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Collaboratives Vision Statement

• Health care in Louisiana will be
• Patient-centered
• Quality-driven
• Sustainable
• Accessible to all citizens

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Collaboratives Concept
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Current Health Care Delivery System

• Low value for the dollar
• Uneven quality of care
• Inequitable access to care

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Relationship Between Quality Medicare
SpendingExpressed By Overall Quality Ranking,
2000-01
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State Comparison of Medicaid Spending

• Medicaid DSH Spending Per
  Enrollee and Uninsured Person

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Uneven Quality
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HbA1c Test in Past Year, HEDIS, Adjusted
Denominator HEDIS Diabetes
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Health Care Spending in Louisiana
Sources PWC Report and 2006 Medicaid Data
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Redesign Approach
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Patient-Centered Approach to Redesign

• Rational organization centered around a given
  individuals level of medical
  complexity and need
• Levels of medical complexity
• Healthy
• Mild to moderately ill
• Complex disease
• End of life

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Translating the Vision into Reality

• Developed Concepts through Blueprint
  Redesign Workgroups
• Staying Healthy (healthy)
• Getting Better (mild to moderately ill)
• Living with Illness and Disability (complex
  disease)
• Coping with the End-of-Life (end-of-life)

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Translating the Vision into Reality

• Utilized Technical Experts
• Received over 12 different plans/ recommendations
  from stakeholders and interested parties across
  the state
• Provided an open dialogue with members of
  collaborative and the public to shape the
  blueprint for redesign
• Developed Concept Paper for a Redesigned Health
  Care System for Region 1

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Key Components of the Redesigned System of Care
for Louisiana

• Medical Home System of Care
• Louisiana Health Care Quality Forum
• Health Information Technology
• Coverage for Services

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Medical Home
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Medical Home System of Care

• Foundation of the Redesign Plan
• Guided by a Personal Primary Care Provider
• Ensures Access to Core Evidence-Based Health Care
  Services
• Ensures System-ness across the Spectrum of
  Care Delivery
• Emphasizes both Patient and Provider
  Accountability

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Region 1 - Medical Home System of Care
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Quality Forum
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Louisiana Health Care Quality Forum

• Establishes quality measures and standards of
  care and monitors system performance based on the
  measures
• Based on standards established by nationally
  recognized bodies such as National Quality Forum
• Provides for public/private partnership dedicated
  to improving the quality of health and health
  care throughout Louisiana across payer and
  provider groups
• Makes data transparent to

• Payers

• Providers

• Consumers

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Health Information Technology
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Health Information Technology

• Creates system-ness
• Allows seamless sharing of electronic information
  to improve patient safety, improve outcomes, and
  increase efficiency in provision of health care
• Informs clinical practice, interconnects
  clinicians, personalizes health care
  and improves population
  health
• Facilitates the data
  reporting for quality improvement

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Coverage for Services
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Health Insurance Connector

• Administrative entity that provides access to
  affordable options for insurance coverage
• Clearinghouse where multiple funding sources can
  be pooled to purchase individual or family health
  coverage
• Provides for education in
  order that individuals can
  make an informed decision
• Facilitates the enrollment
  into a health plan of the
  individuals choice

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Health Insurance Connector

• Connector will be implemented initially in Region
  1 for

• Low income uninsured
• Employer-sponsored or other group health plans in
  which the individual or their family members are
  eligible to participate
• As an option for existing Medicaid and SCHIP
  beneficiaries

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Regional Coverage Expansion

• Expand coverage for uninsured parents with
  incomes up to 200 of the federal poverty level
  (FPL) over the next 5 years
• Expand coverage for uninsured childless adults
  with incomes up to 200 of the federal poverty
  level over the next five years

200 FPL for single individual 19,600
annually 200 FPL for a family of four 40,000
annually
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Statewide Coverage Expansion

• Expand coverage for uninsured children from 200
  to 300 of the federal poverty level through
  premium subsidy funded through Medicaid
• Expand coverage to individuals with serious
  mental illnesses and addictive disorders up to
  200 of the federal poverty level
• Expand coverage to pregnant women with incomes up
  to 200 of the FPL who are not otherwise eligible
  for Medicaid

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Medicare Demonstration for Chronically
Ill/End-of-Life Population

• Includes Medicare beneficiaries with predictably
  reduced life expectancy usually leading to
  death within 18-24 months
• Specialized medical homes serving patients in
  alternative settings using interdisciplinary
  teams
• Coordinate care across health care system and
  settings
• Reduce harmful over-utilization and waste

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Means of Financing Options

• Managed Care Savings
• Community Mental Health Funds
• CNOM (Costs Not Otherwise Matchable)
• DSH (Disproportionate Share Hospital)

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Goals for Reform

• Employment of evidence-based principles
  that focus on performance outcomes,
  translating into better outcomes for the
  dollars spent
• Utilization of information technology
• Establishment of partnerships and provider
  networks that maximize the use of local providers
• Assurance that all funds received are maximized
  according to health system needs
• Plan strategically for the development of solid
  solutions for longer term issues

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Improving Louisianas Health

• Through a system of care that
• Provides a medical home at its heart
• Is patient-centered
• Linked by electronic medical records
• Is quality driven, sustainable, and accessible
  to all citizens

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Kim M. Boyle
Panelists Fred P. Cerise, M.D.,
M.P.H. Secretary, LA DHH Donald R.
Smithburg Executive VP, LSU System CEO, LSU
Health Care Services Div.
Panel Moderator
Kim M. Boyle
Phelps Dunbar, L.L.P.
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Louisianas Health Coverage
Louisianas Health Coverage
Medicaid 20

• A small-business state
• An employer-based system of coverage that leaves
  41 without insurance
• A Medicaid program that makes up a little less
  than half of the gap, leaving 21 uninsured,
  pre-K
• Two-thirds of the uninsured are employed

Uninsured 21
Insured 59.0
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Percent Uninsured in LouisianaBy Area of Work
Source DHH Health Insurance Survey, 2004
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Louisianas Health Coverage
Louisianas Health Coverage

• Providers deal with the
  effects of large uninsured
  population
• LSU and Tulane are a network of doctors, clinics
  and hospitals working to assure access with only
  a fraction of the revenues insurance coverage
  would require
• LSU hospitals provide high quality of care
  within their allocated budget
• LSU embraces Health Care Redesign as a means to
  extend quality care to a greater share of the
  uninsured

Medicaid 20
Uninsured 21
Insured 59.0
And Who Is Rebuilding New Orleans?
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The Storms of 2005

• Lost Big Charity and 160 Clinics
• Lost Veterans Administration hospital
• Rerouted some patients throughout public
  hospitals
• Cancer care in Independence
• Transplant in Lafayette
• Neurosurgery in Baton Rouge (temporary)
• Mental Health?

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The Recovery Plan
Rebuild smarter and stronger.
A partnership between
LSU Medical Center of Louisiana at New Orleans
Veterans Administration
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The Recovery Plan

• An improved delivery system through more
  neighborhood clinics

• New Orleans continues as academic anchor, but
  more specialty services throughout the state, for
  example
• Trauma in Baton Rouge
• Cardiac in Houma and Lafayette

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The Recovery Plan
Timeline

• The New New Orleans
• Land acquisition underway
• Opening day11/11/11

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Health Care Redesign

• Assumptions

• Medical Home Network of Clinics
• Quality Requirements
• Advanced IT/Communications
• Support for Training Health Care Workers

More coverage for patients?
Cost is over 500 million more!
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Health Care Redesign

• The safety net/academic system is a natural fit

• Strong network of clinics statewide
• Strong network of hospitals
• Sophisticated IT systems with electronic file
  cabinet
• THE primary trainer of health professionals

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Questions and Answers
Questions and Answers
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The Honorable Kathleen Babineaux Blanco
The Honorable Kathleen Babineaux Blanco
Governor, State of Louisiana