In October 2006, Louisiana submitted a proposal to the Centers for Medicare and Medicaid Services (CMS) outlining the goals of the Louisiana Health Care Redesign Collaborative. The collaborative seeks to develop a blueprint for an evidence-based, quality-driven health care system for the New Orleans area. Underlying this effort is the recognition that, before Hurricane Katrina, the state's health care system had excess capacity in some ways, but basic services were still inaccessible to many people—leading many to forgo preventive care. The devastation of Hurricane Katrina gave the state an opportunity to rebuild New Orleans' health care system virtually from the ground up. As described in the proposal, the state ultimately hopes to put into place three vehicles to achieve improvements:
- A system of "medical homes," in which patients will choose or be assigned to a primary care physician who is affiliated with a network of hospitals, specialists, and other providers. Medical homes are the foundation of the state's plan, and will provide a wide range of services including health promotion, disease prevention, health maintenance, behavioral health services, patient education, and diagnosis and treatment of both acute and chronic illnesses.
- A health information technology (HIT) system to link all providers in the medical home network through electronic medical records and enable them to coordinate care for their patients. Providers who wish to participate in the medical home system will be required to use interoperable HIT that conforms to nationally accepted standards.
- The Louisiana Health Care Quality Forum, a public–private effort that will develop measures related to health care safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. A private, nonprofit organization will plan, promote, and conduct quality improvement activities for the forum. The forum will work with patients, providers, payers, and other stakeholders to: collect and analyze population health measures across providers and insurers; promote national HIT standards in Louisiana, encourage adoption of electronic health records, and facilitate health information exchange; actively engage with health care organizations to implement quality initiatives, increase cost-effectiveness, and achieve better outcomes; and evaluate and promote evidence-based criteria for medical homes and other health care delivery settings, as well as clinical guidelines for priority populations and services.
Current Status
CMS has responded to the proposal by developing a financial tool to assist the state in its discussion. However, a number of issues still need to be resolved, delaying the development and implementation of components that require federal approval and/or funding. In response to the state's short-term needs, the Department of Health and Human Services awarded $161 million in grants to Louisiana, including $100 million for primary care, $35 million for workforce recruitment and retention, and $26 million for provider stabilization.
Before ending its session in June, the Louisiana Legislature passed resolutions to establish the Louisiana Health Care Quality Forum and appropriated $1 million in funding for its activities. Its board has been selected and has begun meeting. The state is confident that, with the forum in place, it will be able to tackle important quality issues as envisioned by the collaborative.
In addition, the legislature passed the Health Care Reform Act of 2007 (Senate Bill 1), which provides the Department of Health and Hospitals with authorizing legislation to move forward in developing the medical home, HIT, and quality components of the proposal. The legislature also appropriated $10 million to help develop health information exchanges across the state and assist Medicaid providers in adopting electronic health records. Further approval from certain legislative committees will be required before the state submits any state plan amendments or waivers to CMS.
Finally, a bill authorizing expansion of SCHIP coverage for children up to 300 percent of the federal poverty level was passed and signed into law by Governor Blanco and will take effect no later than July 2008. Noting the link between access to care and reimbursement rates, the legislature also passed a measure to increase Medicaid provider rates to 90 percent of Medicare rates.
Moving Forward
To move forward on creation of a medical home system of care for adults, the state needs approval from CMS in a number of areas related to Medicaid. For example, Louisiana is hoping to receive federal support for state plan amendments to increase access to coverage in the hurricane-affected areas and provide a benchmark benefit package based on the medical home model.
Given that Louisiana will hold gubernatorial and legislative elections in 2008, it is not certain which health care reform proposals will be heard in the next legislative session. However, according to Liz Sumrall, senior health care advisor to the Secretary of DHH, "health care policymakers and stakeholders remain fully aware of the opportunities created by the Katrina catastrophe in terms of having the ability to remake the system from the ground up, in a way that provides higher quality and more efficient care to the entire population."
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