Health Care Redesign in Louisiana

US DHHS Secretary Michael O. Leavitt requested the formation of a redesign collaborative to serve as a single body to develop both long and short term recovery plans for the New Orleans area in order to ensure Louisiana secured the most effective engagement of HHS assistance and resources

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 Charge was to build upon the goals set forth by the Governor’s Health Care Reform Panel

Collaborative’s Vision Statement Health care in Louisiana will be… Patient-centered Quality-driven Sustainable Accessible to all citizens

Collaborative’s Concept Delivery System Improvements Coverage for Services

Current Health Care Delivery System Low value for the dollar Uneven quality of care Inequitable access to care

Relationship Between Quality & Medicare Spending Expressed By Overall Quality Ranking,

State Comparison of Medicaid Spending ,000 1,500 2,000 2,500 3,000 3,500 LAALARGAMSTXUS Medicaid & DSH Spending Per Enrollee and Uninsured Person

Uneven Quality

Fraction of Patients Graph shows only CC PCPs with 10+ patients overall level = 65%, red = stat sig diff >.05 from overall level symbol size proportional to # of patients, range 10 to 335 HbA1c Test in Past Year, HEDIS, Adjusted Denominator: HEDIS Diabetes

Health Care Spending in Louisiana $0 $2 $4 $6 $8 $10 $12 $14 $16 $18 $20 Sources: PWC Report and 2006 Medicaid Data Total Private Medicaid Public Medicaid Public UCC $19.4 Billion

Redesign Approach

Patient-Centered Approach to Redesign Rational organization centered around a given individual’s level of medical complexity and need Levels of medical complexity… Healthy Mild to moderately ill Complex disease End of life

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)

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 Translating the Vision into Reality

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

Medical Home

Region 1 - Medical Home System of Care SPECIALIST Physician Services Secondary Tertiary Obstetrics HOSPITAL Emergency Care Inpatient Care Referral as Medically Necessary EMR Care Coordination BASIC MEDICAL HOME 24/7/365 PRIMARY CARE PROVIDER (PEDS; FP; IM – APRN; PA) Preventive Care Primary Care Secondary Care Urgent Care Lab/X-Ray OTHER HEALTH CARE PROVIDERS & EXTENSION SERVICES

Quality Forum

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… PayersProviders Consumers

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

Coverage for Services

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

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

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

Medicare Demonstration for Chronically Ill/End-of-Life Population Includes Medicare beneficiaries with predictably reduced life expectancy; usually leading to death within 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

Means of Financing Options Managed Care Savings Community Mental Health Funds CNOM (Costs Not Otherwise Matchable) DSH (Disproportionate Share Hospital)

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 Improving Louisiana’s Health