The Health Care Reform Act of 2007 (SB1) calls on DHH to implement a medical home system of care that will incorporate the use of health information technology and quality measures to create a safe, patient centered, quality driven, sustainable health care system for Medicaid recipients and low-income uninsured citizens. The Medicaid Reform Committee will counsel the agency as it moves to implement this patient-centered model of care, called “Louisiana Health First.”

“Our citizens deserve health care that meets the unique needs of different individuals and different communities,” said Secretary Levine. “The leaders we have chosen to advise the implementation of Louisiana Health First will help ensure it becomes a model for innovative, sustainable health care.”

Medical home models have been effective at improving the quality of care in other states by creating systems of care that are patient-focused and rely on preventive care, management of chronic disease and coordination of health care services. One such model successfully implemented elsewhere is the Provider Service Network (PSN). PSNs are defined as organized health systems that offer an integrated system of care to Medicaid beneficiaries. PSNs also have substantial participating ownership by a hospital and/or provider group(s), creating a financial incentive to for providers to invest in the long-term health of beneficiaries.

The Medicaid Reform Committee members will utilize their expertise to advise DHH as it crafts the federal waiver applications necessary to implement the Louisiana Health First PSN as a demonstration project.

Each member brings a wealth of expertise in the health care field. Committee members include:

Donnie Batie, MD (Louisiana State Medical Society);

Karen Desalvo, MD (Louisiana Health Care Quality Forum);

Gil Dupre (Louisiana Association of Health Plans).

Ginger Hunt, NP (Louisiana Primary Care Association);

Keith Perrin, MD (Louisiana Chapter of American Academy of Pediatrics);

Paul Salles (Louisiana Hospital Association);

Stephen Taylor, MD (Family Medicine Task Force);

Roxane Townsend, MD (LSU System); and

Carmen Weisner (Louisiana Chapter of National Association of Social Workers);

Clayton Williams (Louisiana Public Health Institute)

By: Louisiana Department Of Health – Thu, 07/24/2008 – 14:34

The meeting focused on three issues:

* Changing the Medicaid program into an HMO-style system in which beneficiaries would choose a managed care plan and use local clinics;

* Determining federal reimbursement to the state for damage Charity Hospital sustained during Hurricane Katrina; and

* Settling claims that the federal government overpaid Louisiana $600 million for Medicaid.

Louisiana Department of Health and Hospitals Secretary Alan Levine said that the Medicaid changes would not disrupt the flow of charity care funding and instead would use funds already allocated by the state and federal government for the program. If an agreement is reached, the proposed changes would first affect three major markets by 2010 — likely Baton Rouge, New Orleans and Shreveport, according to Levine. He said it is unclear whether the changes would increase the state’s Medicaid rolls to reduce the number of uninsured residents or only affect current beneficiaries.

The state officials and Leavitt also discussed how much the federal government will pay for damages to Charity Hospital. The state says the federal government should pay to replace the hospital at an estimated $492 million. However, the Federal Emergency Management Agency estimates the cost in the tens of millions of dollars, according to the Times-Picayune. The state would use the funds to finance a new $1.2 billion teaching hospital in New Orleans. However, if the federal funding is not granted, “it could imperil the project by increasing the subsidies required from the state,” according to the Times-Picayune.

Lastly, the state discussed three Medicaid “disallowances” that the federal government claims it paid Louisiana. Levine said that the state protests the $600 million figure and is working to reduce the amount it must pay back to the government to a fraction of that amount (Moller, New Orleans Times-Picayune, 7/25).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Tue, 07/29/2008 – 19:50

Analysts say the medical home model can provide effective patient-centered care, but its effectiveness depends on the manner of its implementation.

Integrated Health Care

A medical home system, also known as a Provider Service Network (PSN), integrates several different aspects of care provided to Medicaid beneficiaries. Such a system “incorporates the use of health information technology and quality measures to create a safe, patient-centered, quality-driven, sustainable health care system for Medicaid recipients and low-income uninsured citizens,” according to a DHH release.

The agency says PSNs improve quality of care by creating a patient-focused atmosphere that encourages preventive health care, chronic disease management, and coordination of health care services.

According to the DHH news release, “PSNs also have substantial participating ownership by a hospital and/or provider group(s), creating a financial incentive for providers to invest in the long-term health of beneficiaries.”

Demonstration Project

DHH Secretary Alan Levine appointed the committee’s members–who come from health, academic, and advocacy organizations such as the Louisiana State Medical Society, Louisiana Association of Health Plans, Louisiana Chapter of the American Academy of Pediatrics, and Louisiana Public Health Institute–in late July.

“The Medicaid Reform Committee will counsel the agency as it moves to implement this patient-centered model of care, called Louisiana Health First,” said Levine in a news conference after the announcement.

One of the panel’s major tasks will be to advise DHH as the agency crafts the federal waiver applications required for implementing the Louisiana Health First PSN as a demonstration project.

“Our citizens deserve health care that meets the unique needs of different individuals and different communities. The leaders we have chosen to advise the implementation of Louisiana Health First will help ensure it becomes a model for innovative, sustainable health care,” Levine added.

Nothing Really New

“Like all good ideas, everything depends on the particulars and how it is implemented,” said Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute. “If correctly handled, a medical home system can be an effective patient-centered health care option.”

Such systems are already being offered by the private sector, however, Scandlen noted. “I would hope Louisiana would consider recognizing ‘concierge’ physicians [primary care doctors who offer extensive services and focus on individual patients] as medical homes,” he said. “These physicians do everything a ‘medical home’ is supposed to do but without the bureaucracy of some of the medical home models.

“The evidence is growing that medical homes and concierge physicians save more money than they cost, by helping patients better control their chronic conditions and avoid expensive hospital stays,” Scandlen concluded.

Dr Sanjit Bagchi (drsanjitbagchi@gmail.com) writes from India.

By: Heartland.org – Mon, 08/25/2008 – 21:47

He has hinted that he understands the healthcare system’s problems. Governor Jindal is a Republican governor. The Republican Party’s mandate is to transfer all entitlement programs to the private sector. The result will not be favorable to patients or physicians. Total control of Medicaid by the healthcare insurance industry would mean less access to care and greater profits for the healthcare insurance industry.

“Louisiana’s efforts to improve health-care outcomes must put more power in the hands of doctors and patients and should also include broad public health measures, such as improving nutrition and boosting physical education requirements in schools, Gov. Bobby Jindal said Wednesday.”

The social contract of medical care should be between the doctor and the patient. It should not be between a third party such as the government or the healthcare insurance industry and the physicians or patients.

The government should be responsible for broad public health measures such developing a culture of good nutrition and physical activity in the schools and public service campaigns to combat obesity and promote healthy living.

“It really is looking at health, not just health care,” Jindal said, citing Louisiana’s higher rates of diabetes, obesity and asthma as chronic conditions that can be improved through a sharper focus on public health.”

“Without providing specifics, Jindal said he would favor legislation to encourage more physical education in schools and improve nutrition in school vending machines and lunches.”

Governor Jindal’s plan to revise Medicaid is called Louisiana Health First. Early indications are that it will be a sweeping overhaul of the ineffective Medicaid system. Early indications are that it will not support the concept of a social contract between patients and physicians.

“The plan, dubbed Louisiana Health First, would turn over large chunks of the program to privately run managed-care organizations, which would oversee the health care of as many as 380,000 residents, mainly children.”

We have seen that managed care does not work. It is really managed costs. Managed care usually restricts access to care in order to manage costs.

Governor Jindal is right in the public health area but dead wrong with his managed care organization proposal. He will just be providing a money making vehicle for managed care organizations (healthcare insurance industry) while not improving the health of the people of Louisiana.

“Jindal said he hopes to get the changes approved before the Bush administration leaves office Jan. 20, as the change to a new president could delay the state’s plans. “We simply don’t want to start over from scratch,” Jindal said”.

He wants the change before January 20th 2008. He would love to sneak in a plan that would outsource state and federally subsidize Medicaid to managed care organizations. The Republican Party’s goal is to abandon entitlement programs and hand them over to the private sector (healthcare insurance industry).

President Bush tried to privatize social security. If he was successful it would have been a disaster given the present financial crisis. The President is in the process of privatizing Medicare with the Medicare Advantage program. The administration is paying a premium to the healthcare insurance industry to accomplish the transfer at the expense of taxpayers and seniors. Massachusetts is privatizing universal care and experiencing large cost overruns.They will all fail.

Who do you think will lose? Patients and physician will lose. The only reform program that will work will be to provide incentives for consumers to be in control of their healthcare dollar along with a reward system for consumers if they responsibly maintain their health.

Dr. Stanley Feld blogs at http://stanleyfeldmdmace.typepad.com/.

By: Stanley Feld M.D.,FACP,MACE – Mon, 11/03/2008 – 02:41

The proposed plan, outlined in a 65-page concept paper, is designed to cut costs and improve the health outcomes for Medicaid beneficiaries, but details of how it will be financed remain unclear, the New Orleans Times-Picayune reports. The plan also must be approved by the state Legislature and federal government before it is implemented (Moller, New Orleans Times-Picayune, 11/15).

The concept paper outlines some “major reform initiatives” for which the state is seeking federal approval:

* Develop “coordinated care networks” in the Baton Rouge, Lake Charles, New Orleans and Shreveport regions that are similar to private managed care plans and that would provide beneficiaries with preventive health care and chronic disease management services. The networks would be expanded statewide within five years;

* Expand Medicaid to some parents and grandparents of children enrolled in the program. Eligibility for the benefit would require that household income be no more than 50% of the federal poverty level; and

* A demonstration project in Lake Charles that would extend Medicaid coverage to parents, caretaker relatives and childless adults with incomes up to 200% of the federal poverty level (Baton Rouge Advocate, 11/15). People with incomes between 200% and 350% of the poverty level would be able to buy into the program on a sliding scale.

Jindal said, “Our health care system today is not working to help the very people it’s designed to serve,” adding that “doing nothing is not an option.” He said that Medicaid could become financially unsustainable, adding that the program is projected to account for at least 21% of the state’s general fund budget by 2011.

Citing ongoing discussions with the Bush administration over the financial aspects and other details of the plan, Jindal said, “We’re not going to agree to terms (with the federal government) that are not in the best interest of the state.” The negotiations could extend into 2009, he said (New Orleans Times-Picayune, 11/15).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Tue, 11/18/2008 – 18:01

As part of his proposal, Jindal “plans to steer working-poor Medicaid recipients out of the current ‘fee-for-service;’ program” to private managed care plans, where the state would pay a fixed per-patient amount. This is essentially using “Medicaid dollars to fund something like private insurance,” which would allow physicians and hospitals to “be compensated for outcomes — rather than volume of visits and procedures — and get incentive payments for good performance,” according to the Journal.

The editorial continues, “Such a ‘defined contribution’ plan is one way to wrestle run-amok health costs back under control and spend more responsibly,” adding, “It isn’t a new idea,” as congressional Republicans passed a similar reform in 1995 for Medicare, “but it is a good one.” If the state is able to “increase the value of its Medicaid dollars and free up other funding, it will also be able to expand eligibility,” according to the Journal.

Jindal currently is in talks with CMS about a waiver to experiment with the program; however, “If the talks aren’t wrapped up soon, Mr. Jindal will be forced to start over with [President-elect] Barack Obama’s team, which will be hostile to reforms that bank on the private sector,” according to the Journal. The editorial concludes that “Jindal’s proposal is a far better idea” than temporarily increasing the federal medical assistance percentage, which is being considered for inclusion in an economic stimulus package (Wall Street Journal, 11/24).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Mon, 11/24/2008 – 17:27

Levine said that the law is too broad as written and that he “would be uncomfortable making these broad policy decisions without authority to do it.” Levine said, “It’s not enough for the Legislature to say provide for a medical home model, accountability for (health care) providers, managed care reimbursement principals. That gives us an awful lot of latitude.”

State Sen. Joe McPherson (D), who sponsored the law, said, “How can you argue something is too broad in allowing you to do what you want to do? It was intentionally meant to be broad where you don’t preclude moving health care along in the state of Louisiana.” The state House on Monday will hold an all-day health care briefing to examine the details of the proposal (Schuler, Baton Rouge Advocate, 11/25).

Opinion Piece

Gov. Bobby Jindal and Levine write in a New Orleans Times-Picayune opinion piece that their proposal to overhaul Louisiana’s Medicaid program will “transform [the program] into an integrated health system for the poor that provides consumers with choice and a medical home; takes an aggressive stand against fraud and abuse; manages chronic disease and decreases emergency room visits; provides incentives for improved health behaviors and expands the number of consumers who have the dignity of health insurance rather than languishing on the roles of the uninsured.”

They add that the program needs to be restructured because of “systematic failures.” They continue, “We cannot afford to make excuses for having among the highest death rates, highest avoidable hospitalization rates, highest cost and poorest access.” Jindal and Levine conclude that the “results and costs” of Medicaid “should be transparent” and that Louisiana residents “will be healthier as a result” (Jindal/Levine, New Orleans Times-Picayune, 11/24).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Thu, 11/27/2008 – 05:19

Louisiana currently spends 16% of state revenue on Medicaid, up from 10% in 2004, and it is expected to account for 21.5% of state revenue spending by 2011, Levine said. He said that the federal government is projecting an 8% annual Medicaid growth rate in the future, which means next year the state will need an additional $450 million in state and federal funding to sustain the program at current levels.

In addition, Louisiana is within $50 million to $70 million of reaching the $1.5 billion limit for federal participation of uninsured care costs, after which the state must pay 100% of the cost, he said. Based on the estimated growth in uninsured care, the state would have to raise $300 million to $600 million annually in addition to the normal Medicaid program growth if the cap is reached, according to Levine.

Levine touted Gov. Bobby Jindal’s (R) Medicaid overhaul plan — which would change the way that providers are reimbursed and create incentives for improving health and penalties for deficiencies — as the solution to curb spending in the program (Shuler, Baton Rouge Advocate, 12/6).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Tue, 12/09/2008 – 19:46

The American College of Emergency Physicians’ (ACEP) National Report Card on the State of Emergency Medicine confirms other recent reports that give high marks “for nearly every disaster planning, training, and communication systems indicator,” but also show that Louisiana’s emergency rooms are overcrowded, that quality delivered in ERs here lags that of the national average, and that performance results are poor for patients who need truly critical emergency care.

Louisiana Department of Health and Hospitals (DHH) Secretary Alan Levine says the report shows how far the state has come in one sense, and how far it still has to go in another.

“Our great grades on disaster response and preparedness reinforce how well our governor, our state agency staffs, and all of our partners have elevated our preparedness and ability to respond to health-related emergencies since Hurricanes Katrina and Rita in 2005,” Levine said. The state’s “A” grade from ACEP was reinforced today by a separate report from Trust for America’s Health, which scored Louisiana a perfect 10 out of 10 for health emergency preparedness.

“But our poor grades for emergency care should be a wake-up call for our citizens and our lawmakers that we absolutely must change the way we deliver health care in our state,” Levine said. “We need to get our people out of the ER for regular care and into the practice of getting primary care. And our Louisiana Health First health care initiative will do just that.”

In its evaluation of Louisiana’s emergency care environment, ACEP noted that “Louisiana’s low grade in public health and injury prevention points to a critical need for greater investment in and application of targeted, effective strategies to address preventable health risks, injuries, and mortality. Louisiana also needs to improve access to emergency care in the state by addressing current shortages of primary care and mental health providers.”

Louisiana Health First would expand access to affordable health care coverage statewide, provide truly integrated “medical homes” for patients eligible for Medicaid, engage consumers in healthier behaviors and medical choices, and report quality, satisfaction and efficiency data to the public.

“This effort will bring new accountability to the state’s Medicaid program, reward networks that improve the health of people who use their services, and, ultimately, improve health care delivery and results for all citizens of Louisiana,” Levine said.

The National Report Card on the State of Emergency Medicine was made possible in part by funding from the Emergency Medicine Foundation, part of ACEP, with the support of the Wellpoint Foundation and Robert Wood Johnson Foundation. ACEP is the oldest and largest national medical specialty organization representing physicians who practice emergency medicine.

By: Louisiana Department Of Health – Tue, 12/16/2008 – 14:44

Louisiana is seeking about $2.5 million in federal SCHIP reimbursementsfor prenatal care provided to pregnant women who are not U.S. citizens,the Baton Rouge Advocate reports. The state expanded LaCHIP,the states version of SCHIP, earlier this year, and since July, it hasprovided prenatal care to about 1,061 noncitizens. The expansion cost$3.17 million during the first three months.

According to CMSspokesperson Mary Kahn, undocumented immigrants are ineligible forgovernment-funded health programs or services, including SCHIP, exceptin emergency situations. Noncitizens who have green cards can becomeeligible for coverage only after they have been in the country for fiveyears, Kahn said. According to Kahn, Louisiana’s spending on care forpregnant noncitizens is "not reimbursable." Kahn said labor anddelivery is the "only coverage" available for noncitizen pregnant women.

LaCHIPAdministrator Ruth Kennedy said the state contends the cost of careshould be reimbursed by the federal government because LaCHIP providescoverage for the unborn child, not the mother. Kennedy noted a 2002change in SCHIP rules that allows states to cover children "fromconception to birth and up to age 19" regardless of the pregnantwoman’s immigration status. She added that it is cost-effective toprovide prenatal care to pregnant women who are not citizens to ensurethat infants are born healthy.

Non-U.S. citizens in 56 of thestate’s 64 parishes receive prenatal care through the program,according to a state report. The women must fill out applications andhave incomes no higher than 200% of the federal poverty level for afamily of four. The program does not report the immigration status ofpregnant women but would disclose the information if asked by the Department of Homeland Security, Kennedy said (Shuler, Baton Rouge Advocate, 11/14).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily HealthPolicy Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation. 2007 Advisory Board Company and KaiserFamily Foundation. All rights reserved.

By: kaisernetwork.org – Thu, 11/15/2007 – 18:41