Transcript Slide 1

LSU-HCSD Health Care Effectiveness Quarterly Meeting
July 15, 2008
Alan Levine
Secretary, Department of Health & Hospitals
Organizing principles
Our efforts to improve health outcomes are organized around the
following major principles:
• Transparency
• Consumer choice
• Community leadership
• Aligned incentives for
improved outcomes
• Changing consumer
behavior
• Modernizing our safetynet
• Maximizing affordable
coverage
• Portability of benefits
• Health planning &
evaluation of outcomes
Reform background
Louisiana Health Care Redesign Collaborative
• The Collaborative process produced four major
recommendations:
1. expand access to affordable health care coverage;
2. promote the use of health information technology;
3. implement a medical home system of care;
4. form the Louisiana Health Care Quality Forum.
Reform background
Expanding access to affordable coverage
• Coverage expansion – has not moved forward to-date:
– Health care Reform Act of 2007.
• The Louisiana Health Care Redesign Collaborative did
not take-up the rebuilding of MCLNO, nor the role of the
safety-net system in general:
– Expanding coverage, rebuilding MCLNO, and modernizing the
safety-net must be part of an integrated, comprehensive reform.
Health system reform to-date
Health system reform since Governor
Jindal took office has focused on:
• Behavioral health services
• MCLNO business plan
• Health Information Technology
• Transparency
Behavioral health services
In response to the situation in New Orleans, and as a catalyst to
state-wide reform, the state:
• Provided a transformation team led by Col. James McDonough to
Metropolitan Human Service District; implementing management
reform, personnel changes & launching new services.
• Passed legislation providing for expansion of community led human
service districts once new readiness criteria have been met, and
holding these districts responsible for their outcomes.
• Passed legislation providing for Crisis Receiving Centers as single
points of entry for persons in behavioral health crisis & funded startup of new centers;
– 79% of US reported they routinely held psych patients in waiting rooms
for some period of time due to lack of immediate services.
• Increased behavioral health funding by $89 million over last year.
MCLNO business plan
Governor Jindal requested that DHH lead a collaborative
assessment of the business plan with Tulane and LSU
• Results include:
– 2016 Region I bed-demand projections decreased from 966 to 862;
– Bed-size based on patient mix, payor mix, faculty practice patterns and
use and utilization decrease from 416 to 364 med-surg beds;
– The original pro-forma was revised to reflect a projected annual net loss
of $58m in 2016 down from a projected $21m annual profit;
• $130m in annual state general fund subsidy will be required under
this model.
– Both are better than a “do-nothing” scenario which projects a $153m
loss in 2016 if the Interim LSU Hospital continues in operation as is.
Health Information Technology
•
Louisiana Rural Health Information Exchange
– more than $13 million in new FY to connect 7 additional rural hospitals to the
Exchange and provide them with electronic medical records;
•
$4 million for the Louisiana Health Information Exchange to build the
infrastructure and staff for a system that will allow health care providers
state-wide to securely share privacy protected health information and
electronic medical records;
•
DHH is providing hand held e-prescribing devices to 523 Medicaid doctors
statewide:
– 65% of our Medicaid patients receive a pharmacy service;
– Initial estimates place Louisiana’s annual savings at $4.8 million.
•
CMS-EMR demonstration project which will provide incentives to 100
physicians practices in the state to use EHRs, and to report and improve
quality. The state has committed $1 million (matchable) Medicaid dollars to
this effort.
Transparency
• The Consumers Right to Know Act will allow the
state to collect and publish financial and
outcomes data for all health care providers in
Louisiana;
• SB 337 will require the state to collect and
publish the use of funds for uncompensated
care within all non-rural providers.
Reforms to be introduced
• Medicaid reform
• Coverage reform
• Strengthening delivery systems
Medicaid reform
Provider Service Networks
• Medicaid spending in Louisiana grew by approximately
20% last year – a combination of legislatively mandated
rate increases and increased utilization;
• Very little care coordination exists in the current
Medicaid system;
• The Health Care Reform Act of 2007 appropriated $25m
for Medicaid reform based on the medical home
system of care:
– In 2008 legislative regular session, $4.7m was
included for PSNs.
Medicaid reform
Provider Service Networks
• PSNs are contracted networks of providers charged with
delivering care to the defined population who choose
their network. They:
– Would require at least 25% provider ownership;
– Would be awarded through an RFP process within each
demonstration market (New Orleans, Baton Rouge, Shreveport);
– Would implement NCQA patient-centered medical home criteria;
– Could be fee-for-service or prepaid.
DHH recently appointed a Medicaid reform advisory group to assist
in the design of the program
Medicaid reform
Provider Service Networks will be required to implement:
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Enrollee and provider satisfaction reporting;
Anti-fraud and abuse systems;
Robust utilization management;
Aggressive disease management;
Increased EPSDT screening rates for children;
Health IT (EMR, Web-based tools, telemedicine) to
improve care coordination and measure health
outcomes;
• Incentives for high performers.
Children with special needs and persons receiving
developmental services would be carved out of this system
Coverage reform
• Commonwealth Fund links better access to better
quality;
• Different individuals and families have different coverage
needs:
– Coverage reform does not need to be “one-size-fits-all”.
• Reforms working elsewhere:
– Individual and employer tax credits for high-deductible health
plans and health savings accounts;
– Connectors/exchanges which merge multiple-funding streams
for health care from individuals, employers and government to
pay health insurance premiums.
Strengthening delivery systems
Leverage federal and state initiatives in Region I
• Three major federal grants assisting in transforming the
safety-net delivery system in Region I to a more primary
care, community based, medical home model;
• Our intent is that by the end of the grant periods,
participating clinics and practices grow to provide
efficient and effective services:
– to a broad-array of patient and payor types;
– in locations close to where users live and work;
– that decrease the reliance on emergency rooms.
• DHH is convening a strategic planning session in the late
summer to begin system-level sustainability planning
with the grant recipients and other local stakeholders.
Strengthening delivery systems
3-year $100m grant Primary Care Access & Stabilization Grant
• Ensure the ability of the health care infrastructure in the
Greater New Orleans area to:
– Provide primary care and behavioral health services to the lowincome and uninsured population;
– Increase sustainable clinic capacity to meet unmet demand for
these services.
• Twenty-five private and public not-for-profit organizations
delivering care at approximately 70 sites (including LSU);
• $46.3 million awarded to date;
• Delivered services to over 80,000 individuals to-date;
• The population associated with these clinics grew by
over 10% during the last 6-month reporting period.
Funding for this grants expires September 2010
Strengthening delivery systems
$50m Katrina Healthcare Related Professional Workforce Supply Grant
• Recruitment and retention program for the Greater New
Orleans area:
– Available to physicians, dentists, nurses and certain allied health
providers;
– Each must agree to provide substantial care to persons with
Medicaid and the uninsured;
– To date, $35.6m has been awarded and obligated to 958
applicants;
– DHH is negotiating with HHS new recruitment and retention uses
for remaining funds, such as practice management support to
build thriving practices.
The nation, and Louisiana in particular, faces a looming crisis in
medical workforce supply
Strengthening delivery systems
$3.5m ER Diversion Grant
• Intended to lower Medicaid beneficiaries improper use of
costly hospital emergency departments. This program
will:
– Establish alternate public-private networks of non-emergency
care in Baton Rouge and New Orleans;
– Incentivize this network using Medicaid payments to offer
extended evening and weekend hours, and urgent care facilities;
– Target outreach to high users of ER services at the point of
contact within the ER.
This grant is in the implementation planning stage
Questions?