health care redesign in louisiana
Post on 03-Jan-2016
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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
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