Restructuring health care for La. uninsured

• By MARSHA SHULER
• Advocate Capitol News Bureau
• Published: Nov 30, 2008 - Page: 1A - UPDATED: 12:05 a.m.

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A former Louisiana health chief and a state pediatricians’ group say an existing program should serve as the foundation  for health-care restructuring, instead of the private insurance-based plan the Jindal administration is pushing.

They say Louisiana already has the CommunityCARE program that’s been in existence statewide for children and some adults who qualify since late 2003.

The administration is proposing “coordinated care networks.”

In 2005, the federal Centers for Medicare and Medicaid Services  called CommunityCARE “a model of excellence.”  It has also been praised for its early identification of children with developmental problems by the Center for Healthcare Strategies.

Former state health chief David Hood and the Louisiana Chapter of the American Academy of Pediatricians said an updated  program — along the lines of one operating in North Carolina — could be just the remedy for the state’s health-care woes.

But Louisiana Department of Health and Hospitals Secretary Alan Levine said much more needs to be done than what CommunityCARE  offers.

“Why would you want to stop there?” asked Levine.

Today, statewide enrollment in CommunityCARE is 703,966. Enrollees include 582,866 people up to 20 years old, according to the latest DHH statistics.

CommunityCARE
The program provides “medical homes” for those enrolled in Medicaid — the government’s health insurance program for the poor and uninsured. Patients are assigned to physicians who provide preventive and primary care. Currently, there are 1,915 participating providers.

The physicians are the overseers of their care and steer patients to specialists as needed. The physicians are paid extra for managing the patient’s care.

CommunityCARE  uses the “medical home” model of health care that Gov. Bobby Jindal and Levine are now talking about and that former Gov. Kathleen Blanco pushed before them.

One feature that the current state program  does not include is a move toward a private sector insurance model that’s in administration plans. The Jindal administration insists that the private firms would provide the oversight needed to hold physicians, hospitals and other providers more accountable for the type of care delivered and at what price.

In June, the Louisiana Chapter of the American Academy of Pediatrics recommended that the state embark on an expansion of the CommunityCARE program, said Steve Spedale, an academy executive and physician who specializes in neonatal care.