The Louisiana Department of Health today launches an historic transformation of the Medicaid program as the first region of the State goes live with the improved health care service delivery program known as BAYOU HEALTH.
BAYOU HEALTH is the state's new approach to coordinating care for 865,000 Medicaid and LaCHIP recipients. Its focus is on improved access to quality health care and better health outcomes for recipients. Under BAYOU HEALTH, LDH has contracted with five Health Plans - Amerigroup RealSolutions, LaCare, Louisiana Healthcare Connections, Community Health Solutions and UnitedHealthcare Community Plan -- that are responsible for coordinating health care for their members. The four-parish New Orleans-area region and five-parish Northshore region (known as Geographic Service Area A) are the first parts of the state to go live with BAYOU HEALTH. Eligible Medicaid recipients in this area will start receiving services through a BAYOU HEALTH Plan today.
"The launch of BAYOU HEALTH marks Louisiana's first step on the path out of 49th place and on to better health outcomes," said LDH Secretary Bruce D. Greenstein. "This program will transform the way health care is delivered to hundreds of thousands of children, pregnant women and other vulnerable Louisianans. Enrollees will enjoy greater access to more preventive care and better coordinated services-while tax payers enjoy a better return on their investment."
Of the 245,757 eligible recipients in the first phase, the breakdown among Health Plans for BAYOU HEALTH launch is:
- Amerigroup Real Solutions - 43,732
- LaCare - 42,196
- Louisiana Healthcare Connections - 49,538
- Community Health Solutions - 52,741
- UnitedHealthcare Community Plan - 57,139
There were 411 recipients whose enrollment in BAYOU HEALTH is voluntary who elected to remain in the current fee-for-service program.
Each eligible Medicaid and LaCHIP recipient has been afforded the opportunity to choose a Health Plan for themselves or their families, and BAYOU HEALTH outreach staff scheduled numerous events to meet with recipients in person and assist them as needed. Approximately 27 percent of eligible enrollees self-selected the Health Plan they will be enrolled in for the month of February.
Recipients who did not choose a Plan have been assigned to one to begin receiving services through a BAYOU HEALTH Plan effective Feb. 1. These automatic assignments prioritized assigning people to a Health Plan that included their current primary care providers. Recipients will receive a confirmation letter from Medicaid listing which Health Plan they are linked to, be given the opportunity to select a primary care provider (PCP), and will receive health cards from their Plan in addition to their Medicaid cards. If they do not select a PCP, one will be assigned to them by their Health Plan.
Effective Feb. 1, recipients' doctors will be able to determine which BAYOU HEALTH Plan that member belongs to through the Medicaid eligibility verification process. This information will also let providers know which Plan to bill for services or obtain authorizations as needed. Recipients can contact the BAYOU HEALTH enrollment hotline at 1-855-BAYOU-4U (1-855-229-6848) if they have not received a confirmation letter yet and want to know which Health Plan they are in, or they can ask their doctors to verify their eligibility and see their Plan.
Any Medicaid recipients who had surgeries or other medical procedures scheduled before the BAYOU HEALTH launch have been pre-authorized for these procedures under BAYOU HEALTH. Patients who go to the emergency room will be treated, and patients with non-emergency medical needs can go to their usual doctor's offices. In most cases, the doctor's office will participate in that patient's Health Plan. If this is not the case, the doctor's office will refer the patient to an in-network provider.
"People need to know that there's no cause for alarm if they don't have a card from a health plan or a letter from us telling them which plan they are in on Feb. 1," said BAYOU HEALTH Section Chief and Medicaid Deputy Director Ruth Kennedy. "They can absolutely still access services. They just need to show their Medicaid card, and their providers should know what to do."
The launch of BAYOU HEALTH does not end recipients' chance to choose a Health Plan if they decide their current Plan is not a good fit. Medicaid and LaCHIP members have 90 days from when they are enrolled in a Health Plan to switch to another Plan. After that, a recipient can change Health Plans anytime with a good reason, such as their primary care provider leaving the network. After BAYOU HEALTH is implemented statewide on June 1, recipients will have an annual enrollment period in which they can change Plans.
BAYOU HEALTH recipients who wish to change Health Plans can call 1-855-BAYOU-4U (1-855-229-6848) to speak with an enrollment specialist or change Plans online at www.bayouhealth.com.
Federal government gives nod to BAYOU HEALTH contracts
The Centers for Medicare and Medicaid Services has given final approval to the five BAYOU HEALTH Health Plan contracts. The federal agency that oversees Medicaid programs had earlier approved the BAYOU HEALTH concept and signed off on "Readiness Reviews" conducted of the five plans, and had given LDH verbal approval for all plans earlier this week.
Contract approval was the last step in obtaining federal government authorization for BAYOU HEALTH. On Monday, CMS staff informed LDH that the contracts were approved, and sent a formal letter stating the approval to LDH on Tuesday.
Readiness Response Center established
As LDH's BAYOU HEALTH team finalizes the infrastructure needed for the system to go live on Wednesday, team members have engaged a "Readiness Response" mode of operation to quickly answer questions and provide resolution to issues as they arise.
BAYOU HEALTH staff members will be embedded with each of the five Health Plans as well as some of the larger provider groups, such as Children's Hospital in New Orleans, in the first few days of the transition to experience in real time any transition issues that could arise.
Additionally, the team has established a "Readiness Response Center" at LDH headquarters that will be staffed throughout the day to respond to issues as they arise. Top BAYOU HEALTH leaders and architects of the program will be available to help resolve any concerns or answer questions brought to their attention related to the transition. Questions can be directed to email@example.com, and the appropriate staff will address any issues or concerns.
"It is a huge undertaking to tackle generations of poor health outcomes. We are committed to making sure this transition is as smooth for both recipients and providers as it can be," Secretary Greenstein said. "But remember this: Our most important commitment is the one we made nearly four years ago when we began this journey - a commitment to no longer accept the status quo. We are no longer accepting a system that rewards volume over value, a system where people struggle to find a doctor, a system where preventive and primary care takes a back seat to costly emergency room and unnecessary hospital care.
"Instead, we are looking past today, past these initial growing pains, to a system that puts primary care first, where it should be, that ensures that quality outweighs quantity, and that ensures access to care is available when and where people need it. The future of health care in Louisiana is here."
Second area of state to go livewith BAYOU HEALTH begins education, outreach efforts
As New Orleans and the Northshore parishes go live with BAYOU HEALTH on Wednesday, the next area of the state to implement BAYOU HEALTH, known as Geographic Service Area B, is beginning aggressive education and outreach efforts to Medicaid and LaCHIP recipients this week to help them prepare to choose a Health Plan.
GSA B includes the Capital Area Acadiana and South Central Louisiana regions. Click here for a complete breakdown of parishes included. The go-live date for GSA B is April 1. Eligible enrollees in these regions will receive their BAYOU HEALTH Enrollment Packets, which outline their Health Plan choices, beginning in mid-February. A schedule of GSA B enrollment events is available on www.MakingMedicaidBetter.com.
BAYOU HEALTH will be implemented statewide by June 1. Recipients who wish to select a Health Plan should call 1-855-BAYOU-4U (1-855-229-6848) to speak with an enrollment agent or use the automated voice cues to enroll in a plan, attend an enrollment outreach event, enroll online at www.bayouhealth.com, or fill out the paper forms that come in the BAYOU HEALTH Enrollment Packet and mail or fax these back to the Enrollment Center.
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow LDH's blog, Twitter account and Facebook.