louisiana’s practice of medicine · prompt pay rules appeals requirements gme carve-out ....
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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)
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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
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And demand will soon surge
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-
-
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
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-
-
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
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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
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Today’s Reality
The way we finance health care in Louisiana hasn’t changed much since Medicaid was enacted in 1965.
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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
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Questions and Answers
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