Reform Efforts Move Forward on Louisiana Medical News

Reform Efforts Move Forward

By: TED GRIGGS

DHH Secretary Alan Levine

After months of discussion and work, the state released the broad details of its proposal to change the way healthcare is delivered to the poor and asked the federal government for its blessing.

That process could take six months to a year, state Department of Health and Hospitals (DHH) Secretary Alan Levine said.

No one knows how long it will take for stakeholders within the state to agree on the finer details of healthcare restructuring.

"What I would ask people to do is just look at the fundamental concept," Levine said. "They (stakeholders) don't argue with coordinating care. They don't argue with making sure we provide only medically necessary services. They don't argue that we want to get our arms around the growth of the cost of the program."

Those are the concepts that drive Louisiana Health First, Levine said. Those concepts have also been embraced by just about every "thought leader" about healthcare, including advisers to former presidential candidate Al Gore and President Barack Obama.

Levine and Gov. Bobby Jindal's administration want to change the state's $7 billion Medicaid program, which covers 1 million people and is unsustainable in its current form. The federal government has projected the Medicaid budget will grow at 8 percent per year. This means by 2015, Louisiana's Medicaid spending will swell to $11.5 billion.

The proposed healthcare restructuring's benefits include expanding health insurance coverage; coordinating care through primary care physicians, specialists and hospitals; establishing pilot coordinated care networks in Baton Rouge, New Orleans and Lake Charles and making the new Charity Hospital a competitive academic institution.

Dr. Roger Smith, president of the Louisiana State Medical Society, said physicians like the idea of a medical home so that uninsured patients can enjoy regular, and in particular preventive, care.

Those sorts of things have not been done terribly well in the current Medicaid system, Smith said.

The Medical Society also likes the idea of private insurance for Medicaid enrollees, a concept the physicians have championed for a number of years,
Smith said.

"Where we have our main complaint with that is how that insurance system should be made available to our patients," Smith said.

The DHH plan would move all the Medicaid patients into managed care companies, Smith said. Past managed-care efforts controlled costs through capitation, or limiting the amount of money providers were paid for providing care.

The result, in many cases, is that people didn't receive the care they needed, Smith said. Primary care physicians also had to battle through an incredible bureaucracy to initiate care for patients.

Smith said the Medical Society is not anti-DHH, but the physicians are concerned about the details of how the coordinated care networks are going to work.

The restructuring plan has found its share of opponents, among them think tanks such as the Louisiana Public Affairs Research Council (PAR) and Washington, D.C.-based Center on Budget and Policy Priorities.

PAR said the private managed care networks created under Louisiana Health First would result in higher administrative expenses, which would siphon away money from patient care.

Levine has said the reason the Medicaid program is so wasteful and produces such poor patient outcomes is because there has been so little program administration and little accountability.

Meanwhile, the Center on Budget and Policy Priorities said the managed care networks could limit benefits, such as home health visits or prescription drugs. The result would be to place Medicaid beneficiaries in health plans that do not meet their needs, according to the center.

Levine said that a certain amount of resistance takes place because some people may have a hard time adapting to certain kinds of changes.

In the 1960s, the American Medical Association was one of the biggest opponents of Medicare, Levine said. Now, if the federal government tried to get rid of Medicare, the AMA would fight to save the program.

Louisiana Health First has found a number of supporters, including public policy groups such as Blueprint Louisiana and the Council for a Better Louisiana, as well as the Louisiana Academy of Physicians and the Louisiana Primary Care Association, a coalition of health centers for the poor, and Tulane University.

Levine said the state has reached out to the Obama administration, and that Louisiana's waiver request is consistent with the president's stated policies.

"We're very consistent with where the nation is heading," Levine said.

The state has also tried to address, once and for all, the issue of the $771 million that the federal government contends Louisiana owes as a result of federal healthcare overpayments.

The state has asked the federal government to waive that money so Louisiana can use some of that money for healthcare restructuring.

"It's so difficult for us to embark upon these major policy initiatives when we've got this dark cloud hanging over our head," Levine said. "We've got to get past that."