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Charity Hospital

Extent of Insurance Coverage

MedicaidMedicaid19.7%19.7%

UninsuredUninsured20.2%20.2%

InsuredInsured60.0%60.0%

912,000 uninsured (4th in U.S.)912,000 uninsured (4th in U.S.)

891,000 Medicaid eligible891,000 Medicaid eligible

The healthcare of over 40% of Louisiana’s population is dependent on public funding

“Structured systems of care that link hospitals, clinics, and doctors together in an organized fashion, often represent the best hope to begin real programs of managing care, of disease management, and of quality and utilization control.”

-Governor’s Health Care Reform Panel Presentation, 12/16/04

James J. Mongan, MD President and CEO, Massachusetts General Hospital, Brigham and Womens Hospital,

The Harvard Hospitals, Boston

A Good ModelMulti-specialty Clinic System Linked with Hospitals

E. A. Conway Medical Center Monroe

Huey P Long Medical CenterPineville

W O Moss Regional Medical CenterLake Charles

University Medical Center

Lafayette

Earl K Long Medical Center

Baton Rouge

Lallie Kemp Regional Medical

CenterIndependence

Bogalusa Medical Center

Bogalusa

Medical Center of Louisiana atNew OrleansLeonard J. Chabert

Medical Center Houma

University Hospital

Shreveport

State Public Hospitals and ClinicsState Public Hospitals and Clinics

-Charity Hospital-University Hospital

Katrina

Rita

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2 Restore, Stabilize and RedistributeSpecialty Services

Envisioned System-wide Distribution of Specialty Services

Tertiary and Referral HospitalsMCLNO and Earl K. Long

Foundation HospitalsW. O Moss and Lallie Kemp

Secondary and Specialty HospitalsLeonard J. Chabert, University Medical Center, Bogalusa Medical Center, Huey P. Long

Mission-driven to care for the uninsured and provide Mission-driven to care for the uninsured and provide training opportunities for future health professionalstraining opportunities for future health professionals

A statewide Safety Net system in which everyone is A statewide Safety Net system in which everyone is eligible for careeligible for care No income thresholdsNo income thresholds No local residency requirementsNo local residency requirements No enrollment processNo enrollment process People with means expected to payPeople with means expected to pay

Provides comprehensive inpatient, outpatient Provides comprehensive inpatient, outpatient hospital and primary and specialty clinic serviceshospital and primary and specialty clinic services 350+ clinics350+ clinics Relies on medical residents for a substantial component of Relies on medical residents for a substantial component of

physician care as part of GME training programsphysician care as part of GME training programs

The LSU Hospitals and ClinicsIn Brief

LSU InitiativesDisease Management

Asthma

Diabetes

Congestive Heart Failure

HIV/AIDS

Cancer

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77BMC

92HPL

94UMC

98LJ C

95MCL

97EKL

Rank in USARank in LAScore

Median LA score = 89Median USA score = 91

Quality – Examples of ExcellenceLSU Hospital Ranking on Acute MI

5 Stars = Highest Quintile

Compliance With Recommended Treatments

USA Today, 9/06,Based on CMS Data

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RHCsaRHChs others

L-BMCFQHCs L-LAK L-EACL-SHR L-MCL

L-UMCL-HPLL-W OML-EKL

L-LJC

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

Fra

ctio

n of

Pa

tient

s

Graph shows only PROVIDER GROUPS with 10+ patients

overall level = 44%, red = stat sig diff > .05 from overall levelsymbol size proportional to # of patients, range 36 to 9010

Mammogram in Past 2 Years, HEDIS , unadjusteddenom: HEDIS mammography, December 31, 2003

Quality – Examples of Excellence% With Mammogram in Past Two Y ears

Other MedicaidProviders

LSU Hospitals

The LSU Hospitals had a higher percentage of patients Receiving mammograms in the past two years, compared to Other Medicaid providers.

SOURCE: DHH

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Core Elements of LSU Health Care Vision

1 Rebuild and Improve I nfrastructure

2 Restore, Stabilize and Redistribute Specialty Services for a Dispersed Population Through a Multi-Hub Model

Extend Quality and Operational Improvement Strategies4

3 Disperse primary-care to sites close to the patient population

Prepare to Sustain Dual Mission in a Redesigned Health Care System5

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Expanded clinics providing primary care nearer patients

Stronger and closer relationships with community clinics and physicians, including electronic access to patient information

The concept of a “medical home” for every patient in the form of an appropriate physician to oversee all the patient’s care

Payment of physicians for care to the uninsured

Expanded coverage through Medicaid

5 Prepare for Health Care Redesign

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University HospitalUniversity HospitalPreliminary Clinic SitesPreliminary Clinic Sites

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22

33

44

CC

Proposed Clinic Sites

One remaining mobile clinic may serve as specialty care clinic at University Hospital

55

77

88

Mobile Clinics1. Douglas Senior High

/Drew Elementary3820 St. Claude

2. Henderson Middle1912 L B Landry

3. Martin Behrman Elementary715 Opelousas

4. McDonough 28 Junior High2733 Esplanade

5. Jackson Barracks6. 1300 Myrtle Street -

Kenner (not shown)

Facility-Based Clinics7. O. Perry Walker

2832 General Meyer8. Oakwood

128 Wright

3 Decentralize Primary Care

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LSU/ VACollaborative Opportunities Study Group

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LSU and the VA - Natural Partners

Long history of collaboration through purchase of services

Both are public mission hospitals

Both provide more extensive outpatient than inpatient care

Both have integrated delivery systems with documented High Quality

Both had facilities effectively destroyed by Katrina

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The LSU/ VA Memorandum of Understanding

“…conduct an analysis to determine what, if any,mutually beneficial consolidation should occur between the New Orleans Veterans Affairs MedicalCenter (VAMC) and LSU-HCSD.”

Service, quality, access, cost, efficiency, management, practicality, legal and regulatory, logistics

Clinical areas Lab, Radiology Operating Rooms

Facility Sharing Parking Power Plant

Support Service Sharing Food service, Housekeeping Information Systems

Consider . . . .

Also. . .

Consider the alternative of developing nocooperative relationship with the VA.

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The Focus of the Collaborative Opportunities Study Group

Construction of a single campus Separate VA and LSU “towers” Shared functions, services, areas

Site in current medical district

Separate hospital identities maintained

“Sharing” defined by contractual relationships

Big Charity V.A. – New Orleans

A signature projectIn the recovery ofSouth Louisiana

The Charity Model

Louisiana needs all of its programs for the uninsured, and more are required as well. We don’t need to tear down systems of care that we have, but instead should find ways to secure and improve these systems and to supplement them with more.

A Principle for Reform