Health-care model for state in works
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The Jindal administration plans to roll out networks in Baton Rouge, New Orleans and Shreveport that could eventually overhaul the state’s health-care system for the poor, moving to a model where patient treatments and results are monitored.
Alan Levine, secretary of the state Department of Health and Hospitals, said the “provider service networks” will be established within the Medicaid program. Levine was the keynote speaker at the Louisiana Health Care Quality Forum Spring Summit.
“It’s a way of introducing to the state an integrated delivery system of coordinated care, a framework where Medicaid moves away from its old model of being a payer of claims and moves to a model where we monitor the system, where we provide incentives for improved outcomes, and where we generally try to take baselines of consumer behaviors and try to improve those outcomes,” Levine said.
Levine said the current system is a failure, an outdated, 40-year-old model that does little to improve patients’ health or control costs.
The Louisiana Health Care Quality Forum’s members have pushed the state to adopt a system where primary-care physicians and clinics provide medical homes. The doctors coordinate care, referring patients as needed to specialists, hospitals and other providers in a type of managed-care network.
The network approach has proven successful in Louisville, Ky., Florida and North and South Carolina, Levine said. In 2003, North Carolina invested $8.5 million in the network and cut its Medicaid spending by $63 million.
The approach saved taxpayers more than $231 million in the state’s 2005 and 2006 fiscal years. Last year, Harvard University named the program one of its Innovations in American Government Awards winners.
Gov. Bobby Jindal’s budget includes $5 million to implement the provider service network model, Levine said. The state will provide administrative money on the front end for networks.
The budget also includes $3.5 million for chronic disease management, Levine said. By aggressively managing care for patients with asthma, diabetes, heart disease, sickle cell anemia and other chronic conditions, the state hopes to reduce expensive emergency room visits and hospitalizations.
Levine said there has already been a substantial amount of interest in creating the networks from LSU, which manages the state’s charity hospital and clinic system, as well as out-of-state-firms.
“Medicaid in Louisiana has to move away from the fee-for-service model. Eventually, we have got to get to a place where we change the system of financing so that we provide the dollars on the front end to the provider service network,” Levine said.
This will give the network the flexibility to tailor its system to the patients’ needs, Levine said. For example, under the current Medicaid model, the pay for neurosurgeons is set so the system can’t offer more money to attract a neurosurgeon.
But a provider service network can, Levine said.
The state will limit the number of networks because each must have enough patients to maximize its resources, Levine said. DHH has not decided how those networks will be chosen.
Levine said major challenges remain for implementing medical homes, including changing the way providers are paid.
Under the current reimbursement system, physicians have to see twice as many patients to make the same money they did 15 or 20 years ago, Levine said The result is that patients wait longer to spend less time with their doctors, the antithesis of what medical homes are.
Alan Levine, secretary of the state Department of Health and Hospitals, said the “provider service networks” will be established within the Medicaid program. Levine was the keynote speaker at the Louisiana Health Care Quality Forum Spring Summit.
“It’s a way of introducing to the state an integrated delivery system of coordinated care, a framework where Medicaid moves away from its old model of being a payer of claims and moves to a model where we monitor the system, where we provide incentives for improved outcomes, and where we generally try to take baselines of consumer behaviors and try to improve those outcomes,” Levine said.
Levine said the current system is a failure, an outdated, 40-year-old model that does little to improve patients’ health or control costs.
The Louisiana Health Care Quality Forum’s members have pushed the state to adopt a system where primary-care physicians and clinics provide medical homes. The doctors coordinate care, referring patients as needed to specialists, hospitals and other providers in a type of managed-care network.
The network approach has proven successful in Louisville, Ky., Florida and North and South Carolina, Levine said. In 2003, North Carolina invested $8.5 million in the network and cut its Medicaid spending by $63 million.
The approach saved taxpayers more than $231 million in the state’s 2005 and 2006 fiscal years. Last year, Harvard University named the program one of its Innovations in American Government Awards winners.
Gov. Bobby Jindal’s budget includes $5 million to implement the provider service network model, Levine said. The state will provide administrative money on the front end for networks.
The budget also includes $3.5 million for chronic disease management, Levine said. By aggressively managing care for patients with asthma, diabetes, heart disease, sickle cell anemia and other chronic conditions, the state hopes to reduce expensive emergency room visits and hospitalizations.
Levine said there has already been a substantial amount of interest in creating the networks from LSU, which manages the state’s charity hospital and clinic system, as well as out-of-state-firms.
“Medicaid in Louisiana has to move away from the fee-for-service model. Eventually, we have got to get to a place where we change the system of financing so that we provide the dollars on the front end to the provider service network,” Levine said.
This will give the network the flexibility to tailor its system to the patients’ needs, Levine said. For example, under the current Medicaid model, the pay for neurosurgeons is set so the system can’t offer more money to attract a neurosurgeon.
But a provider service network can, Levine said.
The state will limit the number of networks because each must have enough patients to maximize its resources, Levine said. DHH has not decided how those networks will be chosen.
Levine said major challenges remain for implementing medical homes, including changing the way providers are paid.
Under the current reimbursement system, physicians have to see twice as many patients to make the same money they did 15 or 20 years ago, Levine said The result is that patients wait longer to spend less time with their doctors, the antithesis of what medical homes are.
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