Health Care Redesignin

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 Louisiana Health Care Redesign CollaborativeCollaborative

Created by HCR 127Created by HCR 127

Purpose was to advise DHH in the Purpose was to advise DHH in the development of a blueprint for redesign of development of a blueprint for redesign of the health care systemthe health care system

Focus was on the hurricane-affected parishes Focus was on the hurricane-affected parishes of the Orleans Region area of the stateof the Orleans Region area of the state

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

Collaborative’s Vision Statement

Health care in Louisiana will be…

Patient-centered

Quality-drivenSustainable

Accessible to all citizens

Collaborative’s Concept

Delivery Delivery System System

ImprovemeImprovementsnts

Coverage Coverage for for

ServicesServices

Current Health Care Delivery Current Health Care Delivery SystemSystem

Low value for the dollarLow value for the dollar

Uneven quality of careUneven quality of care

Inequitable access to careInequitable access to care

Relationship Between Quality & Medicare Relationship Between Quality & Medicare SpendingSpendingExpressed By Overall Quality Ranking, Expressed By Overall Quality Ranking, 2000-012000-01

State Comparison of Medicaid State Comparison of Medicaid SpendingSpending

0

500

1,000

1,500

2,000

2,500

3,000

3,500

LA AL AR GA MS TX US

Medicaid & DSH Spending Medicaid & DSH Spending Per Enrollee and Uninsured PersonPer Enrollee and Uninsured Person

Uneven Quality

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

Fract

ion

of

Pati

en

ts

Graph shows only CC PCPs with 10+ patientsoverall 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, HbA1c Test in Past Year, HEDIS, Adjusted Denominator: HEDIS, Adjusted Denominator: HEDIS Diabetes HEDIS Diabetes

Health Care Spending in Health Care Spending in LouisianaLouisiana

$0$2

$4

$6$8

$10

$12$14

$16

$18$20

Sources: PWC Report and 2006 Medicaid Data

TotalPrivate MedicaidPublic Medicaid Public UCC

$19.4 $19.4 BillionBillion

Redesign Approach

Patient-Centered Approach to Patient-Centered Approach to RedesignRedesign

Rational organization centered Rational organization centered around a given individual’s around a given individual’s level of medical complexity level of medical complexity and need and need

Levels of medical complexity…Levels of medical complexity…

HealthyHealthy

Mild to moderately illMild to moderately ill

Complex diseaseComplex disease

End of lifeEnd of life

Translating the Vision into Translating the Vision into RealityReality

Developed Concepts through Developed Concepts through Blueprint Redesign Workgroups Blueprint Redesign Workgroups

Staying Healthy (healthy)Staying Healthy (healthy)

Getting Better (mild to moderately ill)Getting Better (mild to moderately ill)

Living with Illness and Disability Living with Illness and Disability (complex disease)(complex disease)

Coping with the End-of-Life (end-of-Coping with the End-of-Life (end-of-life) life)

Utilized Technical ExpertsUtilized Technical Experts

Received over 12 different plans/ Received over 12 different plans/ recommendations from stakeholders and recommendations from stakeholders and interested parties across the stateinterested parties across the state

Provided an open dialogue with members of Provided an open dialogue with members of collaborative and the public to shape the collaborative and the public to shape the blueprint for redesignblueprint for redesign

Developed Concept Paper for a Redesigned Developed Concept Paper for a Redesigned Health Care System for Region 1Health Care System for Region 1

Translating the Vision into Translating the Vision into RealityReality

Key Components of the Key Components of the Redesigned System of Care for Redesigned System of Care for LouisianaLouisiana

Medical Home System of CareMedical Home System of Care

Louisiana Health Care Quality Louisiana Health Care Quality ForumForum

Health Information TechnologyHealth Information Technology

Coverage for ServicesCoverage for Services

Medical Home

Region 1 - Medical Home System Region 1 - Medical Home System of Careof Care

SPECIALISTPhysician Services

Secondary Tertiary

Obstetrics

HOSPITAL

Emergency CareInpatient Care

Referralas

MedicallyNecessary

EMR

EMR

EMR

EMR

CareCoordination

BASIC MEDICAL HOME

24/7/365PRIMARY CARE PROVIDER(PEDS; FP; IM – APRN; PA)

Preventive CarePrimary Care

Secondary CareUrgent CareLab/X-Ray

OTHERHEALTH CARE PROVIDERS

&EXTENSION SERVICES

Quality Forum

Louisiana Health Care Quality Louisiana Health Care Quality ForumForum

Establishes quality measures and standards of Establishes quality measures and standards of care and monitors system performance based on care and monitors system performance based on the measuresthe measures

Based on standards established by nationally Based on standards established by nationally recognized bodies such as National Quality Forumrecognized bodies such as National Quality Forum

Provides for public/private partnership dedicated Provides for public/private partnership dedicated to improving the quality of health and health care to improving the quality of health and health care throughout Louisiana across payer and provider throughout Louisiana across payer and provider groupsgroups

Makes data transparent to…Makes data transparent to…PayersPayers ProvideProvide

rsrsConsumerConsumerss

Health Information Technology

Health Information TechnologyHealth Information Technology

Creates “system-ness”Creates “system-ness”

Allows seamless sharing of electronic Allows seamless sharing of electronic information to improve patient information to improve patient safety, improve outcomes, and safety, improve outcomes, and increase efficiency in provision of increase efficiency in provision of health carehealth care

Informs clinical practice, Informs clinical practice, interconnects clinicians, interconnects clinicians, personalizes health care personalizes health care and improves population and improves population healthhealth

Facilitates the data Facilitates the data reporting for quality reporting for quality improvementimprovement

Coverage for Services

Health Insurance ConnectorHealth Insurance Connector

Administrative entity that provides Administrative entity that provides access to affordable options for access to affordable options for insurance coverageinsurance coverage

Clearinghouse where multiple funding Clearinghouse where multiple funding sources can be pooled to purchase sources can be pooled to purchase individual or family health coverageindividual or family health coverage

Provides for education in Provides for education in order that individuals can order that individuals can make an informed decisionmake an informed decision

Facilitates the enrollment Facilitates the enrollment into a health plan of the into a health plan of the individuals’ choiceindividuals’ choice

Regional Coverage ExpansionRegional Coverage Expansion

Expand coverage for uninsured parents Expand coverage for uninsured parents with incomes up to 200% of the federal with incomes up to 200% of the federal poverty level (FPL) over the next 5 yearspoverty level (FPL) over the next 5 years

Expand coverage for uninsured childless Expand coverage for uninsured childless adults with incomes up to 200% of the adults with incomes up to 200% of the federal poverty level over the next five federal poverty level over the next five yearsyears

200% FPL for single individual = $19,600 annually200% FPL for a family of four = $40,000 annually

Statewide Coverage ExpansionStatewide Coverage Expansion

Expand coverage for uninsured children Expand coverage for uninsured children from 200% to 300% of the federal from 200% to 300% of the federal poverty level through premium subsidy poverty level through premium subsidy funded through Medicaidfunded through Medicaid

Expand coverage to individuals with Expand coverage to individuals with serious mental illnesses and addictive serious mental illnesses and addictive disorders up to 200% of the federal disorders up to 200% of the federal poverty levelpoverty level

Expand coverage to pregnant women Expand coverage to pregnant women with incomes up to 200% of the FPL with incomes up to 200% of the FPL who are not otherwise eligible for who are not otherwise eligible for MedicaidMedicaid

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

Includes Medicare beneficiaries with Includes Medicare beneficiaries with predictably reduced life expectancy; predictably reduced life expectancy; usually leading to death within 18-24 usually leading to death within 18-24 monthsmonths

““Specialized medical homes” serving Specialized medical homes” serving patients in alternative settings using patients in alternative settings using interdisciplinary teamsinterdisciplinary teams

Coordinate care across health care Coordinate care across health care system and settingssystem and settings

Reduce harmful over-utilization and Reduce harmful over-utilization and wastewaste

Means of Financing Means of Financing OptionsOptions

Managed Care SavingsManaged Care Savings

Community Mental Community Mental Health FundsHealth Funds

CNOM CNOM (Costs Not Otherwise (Costs Not Otherwise Matchable)Matchable)

DSH DSH (Disproportionate Share (Disproportionate Share Hospital)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