Louisiana’s Practice of Medicine Delivery of care in the future

Bruce D. Greenstein Secretary

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DHH Top Priorities

• FY 2012 budget planning and implementation

• Building a smarter, more efficient agency

• Health Information Technology (HIT)

• Fighting Fraud and Abuse

• MMIS Procurement

• Impact of National Health Care Reform implementation

• Greater New Orleans Community Health Connections (GNOCHC) Waiver

• CommunityCare 2.0

• Coordinated System of Care (CSoC)

• Coordinated Care Networks (CCNs)

La.’s Medicaid costs are growing

3

3,6

48

.1

4,0

76

.4

4,3

62

.8

4,9

82

.2

5,1

81

.1

4,7

56

.0

5,2

02

.8

5,9

21

.7

6,3

50

.4

6,6

38

.6

6,6

11

.5

0.0

1,000.0

2,000.0

3,000.0

4,000.0

5,000.0

6,000.0

7,000.0

Louisiana Medicaid Expenditures (in millions)

34% Growth in Costs

Only a 12% Growth in Enrollment

1.05 M Enrollees

1.175M Enrollees

And demand will soon surge

-

-

-

259

,5

42

282

,6

57

306

,7

66

331

,9

04

340

,2

01

348

,7

06

357

,4

24

366

,3

60

37

5,5

19

3

84

,9

07

-

-

-

1

86

,8

35

1

91

,5

05

1

96

,2

93

2

01

,2

00

20

6,2

30

2

11

,3

86

2

16

,6

71

2

22

,0

88

2

27

,6

40

2

33

,3

31

2,906 8,718 14,530

20,341

24,700

26,153

27,606

27,606 27,606

27,606

27,606

27,606 27,606

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023

Crowd out

population

Currently eligible

but not enrolled

parents

Expansion

population

In first year (2014) = 467K

Overnight 40% Growth

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Louisiana’s Estimated Enrollment Impact from Affordable Care Act for SFY’s 2011-23

Working with providers

• Freeze on rate cuts for remainder of fiscal year

• History of close collaboration with providers, with great examples of success:

– HCBS advocates & providers

– Dentists

– Pharmacists

– Doctors

Today’s Reality

The way we finance health care in Louisiana hasn’t changed much since Medicaid was enacted in 1965.

6

7

Birth Outcomes

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America’s Health Rankings

Challenges:

• High prevalence of obesity (33.9%)

• High incidence of infectious disease (23.8 cases/100,000 population)

• High rate of preventable hospitalizations (97.3 discharges / 1,000 Medicare enrollees)

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Louisiana State Rank

Infant Mortality: 48

Low-birthweight babies: 49

Child death rate: 47

Children in poverty: 48

And again.

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The “Troubling Triangle”

Low Quality

Good Providers

Broken System

High Costs

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FOCUS on what we can FIX

• Goal #1 of our reforms: Improve health outcomes

– Birth outcomes

• Low-birthweight

• Infant Mortality

– Chronic disease

• Cardiovascular

• Diabetes

• Cancer

– Preventive medicine

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“Making Medicaid Better”

• Move from fee-for-service to Coordinated Care Networks (CCNs)

• Current system values quantity over quality

• CCNs reward value over volume

• What we get: o Better outcomes o Savings and budget predictability o Readiness for expansion o Payment reform – more rational incentives o Greater coordination of care

CCNs are designed to break the predictable path and provide better health outcomes for Louisiana residents.

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• Numerous forums, meetings and legislative hearings

• Everywhere we went, witnessed pent-up frustration from a poor performing program

Collaboration is needed for success

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We’ve learned from best practices

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What we changed What it does Ensures that the majority of dollars go

toward providing health care

Guarantees that providers are paid no

less than the Medicaid rate

Limits number of plans to a manageable

amount; ensures best plans are selected

Protects providers from cash flow

problems

Gives providers and enrollees consistent

recourse from denied claims and payments

Protects Graduate Medical Education from

potential compromise.

Medical Loss Ratio

Absolute Rate Floor

Competitive

Procurement

Prompt Pay Rules

Appeals

Requirements

GME Carve-Out

Questions and Answers

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