Making Medicaid Better Newsletter 2.1.2011

Message from Medicaid Medical Director Dr. Rodney Wise

The New Year is always a time to look forward and plan changes, and this year, positive changes are occurring in our state's Medicaid program. In mid-January, we presented the department's improved proposal for implementing Coordinated Care Networks (CCN) to the Legislative Health and Welfare committees. As we move forward, we believe this plan will provide better health outcomes and a higher quality of life for our recipients.

The CCN proposal is the culmination of many years of hard work and research from the dedicated staff in Medicaid and other areas of DHH. Madeline McAndrew, who has been an integral adviser on DHH's major health care reform efforts for the past decade, and Ruth Kennedy, a longtime Medicaid deputy and program director who has been nationally recognized for her work to simplify enrollment and expand health care coverage for Medicaid recipients, particularly children, are the two main architects of this proposal, along with my input as Medicaid medical director.

Together, we have invested much time in examining Medicaid managed care programs in other states to get a sense for what works well and what we could do better. Because Louisiana is one of the few states not using a CCN approach for managed care in Medicaid, we had the advantage of meeting with other state Medicaid program directors to ask what they would do differently if starting a program today to coordinate and improve care for enrollees. We have incorporated these lessons learned into the Louisiana proposal.

Maddie has used her more than a decade of experience with previous reform projects, including Gov. Mike Foster's Committee of 100 to transform Medicaid (1998), Gov. Blanco's Health Care Reform Panel and Committees (2004) and federal Department of Health & Human Services Secretary Michael O. Leavitt's post-Katrina Health Care Redesign Collaborative with the regional health consortia (2005-2006), and used much of those debates and discussions to help shape today's proposal. Some examples of these recommendations are the medical home model; monitoring health care services utilization; network development and adequacy requirements; and the appeals process. The history of these efforts shows us that what we're proposing through CCNs has the potential to make a real and lasting difference, improving the lives of our citizens.

As a medical provider, I am also pleased to say our continued collaboration, particularly throughout the past two months, with hospitals and health care provider groups as we progressed toward an improved CCN proposal has yielded productive developments. We've received letters of support from many organizations, including the Louisiana Primary Care Association, Louisiana Medical Association and Louisiana Independent Physicians Association.

I am convinced CCNs are the right and best way to treat our state's sickest and most vulnerable patients. As we move forward, I hope all of you will actively participate in this process. Please visit www.MakingMedicaidBetter.com to see the latest updates and information on our proposal, and contact coordinatedcarenetworks@la.gov to submit questions or request information.

Sincerely,
Rodney Wise, M.D.
Medicaid Medical Director

In Case You Missed It: Letters in Support of Making Medicaid Better

The Department of Health and Hospitals has received letters of support for the proposal to implement CCNs in Medicaid from multiple health care organizations and advocacy groups, and others have written letters to the editor in support of the proposal. See the letters of support online.

Draft Notice of Intent

DHH has posted the Draft Notice of Intent for the CCN model and related materials online at www.MakingMedicaidBetter.com. Please visit the site to see the latest information. This site will be updated frequently, and the public is advised to check here often for current details.

Making Medicaid Better Next Steps

The Department of Health and Hospitals is moving forward with an improved proposal for implementing CCNs in Medicaid. The following is a timeline of next steps as the state progresses with the Making Medicaid Better initiative:

•    In mid-January, DHH presented the improved plan for Coordinated Care Networks, which incorporates stakeholder input received to date, to the Legislative Health and Welfare committees, and formally submitted a draft Notice of Intent to implement CCNs to the Legislative Fiscal Office - the first of many steps in the rulemaking process. The agency anticipates that the notice will be published in the Louisiana Register in February.

•    DHH will enact a public comment period on the Notice of Intent, with ample opportunities for input. More details about these opportunities will be made available in the coming weeks.

•    Following Legislative oversight and input, the RFP process will be made public in the spring, and plans would be chosen in late summer.

•    DHH anticipates enrolling recipients in three phases, targeting the first group to choose plans in late fall 2011, with CCN coverage for those recipients taking effect Jan. 1, 2012. All eligible recipients would be enrolled in a CCN by May 1, 2012.

The DRAFT Notice of Intent and updates to the CCNs proposal are available online. This site will be updated frequently, and the public is advised to visit here often to view current information.

Featured Question: What is Happening with the CommunityCARE Program?

CommunityCARE, DHH's primary care case-management program that links Medicaid recipients to a primary care provider, recently transitioned to an enhanced version, which incorporates pay-for-performance measures. The new program, known as CommunityCARE 2.0 (CC 2.0), ensures greater coordination of care for Louisiana's Medicaid population, and creates a bridge toward CCN implementation.

As of Jan. 1, 2011, all CommunityCARE primary care providers and CommunityCARE recipients were transitioned to CC 2.0, with linkages intact. Providers who wanted to remain in CC 2.0 had to complete an attestation form by Jan. 31. Providers who do not wish to remain in CC 2.0 must provide written notification to DHH immediately so their enrollees can be given the opportunity to select a new provider.

Primary care providers must meet basic participation requirements to be part of the CC 2.0 program, including participating in the LINKS electronic immunization database program, providing direct medical care for at least 20 hours per week, ensuring Internet access and providing an e-mail address for administrative transactions.

The primary care provider will be paid a base management fee of $1.50 per linked enrollee. Through the pay-for-performance portion of CC 2.0, providers also can earn enhanced rates per member by providing extended office hours, attaining patient-centered medical home status (meeting either National Committee for Quality Assurance or Joint Commission on Accreditation of Healthcare Organization standards), achieving the lowest rates of low-level emergency room utilization and performing EPSDT screenings.  Payments for the pay-for-performance measures will be quarterly, with the first payments expected in April 2011. A provider who meets or excels in each pay-for-performance measure could be paid as much as $3.75 per-member per-month, which includes the $1.50 base pay.

Details of the program, including additional information on pay-for-performance measures and rates, can be found at www.la-communitycare.com.

Why Does Coordinating Care Matter?

Electronic health records (EHR) can help medical professionals better coordinate patients' care, exchange information securely, and avoid medical errors such as dispensing improper medication, mislabeling test results or misreading handwritten treatment instructions. EHR also allow providers to spend less time on administrative processes and more time providing direct patient care. The Louisiana Medicaid EHR Incentive Program is offering payments to providers and hospitals who wish to adopt this technology to better coordinate their patients' care. Learn more at www.MakingMedicaidBetter.com.

Contact Us

Your feedback is important to us as we move forward in transforming Louisiana's Medicaid program. For the latest information or to share your comments, please visit www.MakingMedicaidBetter.com, e-mail coordinatedcarenetworks@la.gov, or call toll-free 1-888-342-6207.