LSUHCSD Health Care Effectiveness Quarterly Meeting

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LSU-HCSD Health Care Effectiveness Quarterly
Meeting July 15, 2008 Alan Levine Secretary,
Department of Health Hospitals
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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 safety-net
• Maximizing affordable coverage
• Portability of benefits
• Health planning evaluation of outcomes

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Reform background
Louisiana Health Care Redesign Collaborative

• The Collaborative process produced four major
  recommendations
• expand access to affordable health care coverage
• promote the use of health information technology
• implement a medical home system of care
• form the Louisiana Health Care Quality Forum.

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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.

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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

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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 start-up 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.

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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.

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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 Louisianas 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.

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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.

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Reforms to be introduced

• Medicaid reform
• Coverage reform
• Strengthening delivery systems

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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.

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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
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Medicaid reform
Provider Service Networks will be required to
implement

• 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
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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.

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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.

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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 low-income 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
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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
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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
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Questions?