Making Medicaid Better Newsletter 2.10.2011

DHH Secretary, State Health Officer Invite Physicians to Attend Inaugural DHH Medical Directors' Summit Feb. 16

Dear Colleagues,

As part of our ongoing efforts to create and maintain a strong, effective dialogue with the health care professionals of our state, the Louisiana Department of Health & Hospitals is hosting the inaugural Medical Directors' Summit.  Our goal is to share our current initiatives, learn about major health care issues in our community, and listen to feedback from you, the physicians and medical directors of the state, to build community among physicians and the department. Continuing Medical Education Units (CME) credits will be available for this meeting.

The summit will take place Wednesday, Feb.16 at Pennington Biomedical Research Center, located at 6400 Perkins Road, Baton Rouge, Louisiana (see Google map).  Registration begins at 12:30 p.m., with the meeting formally commencing at 1 p.m. and adjourning at 5 p.m. The meeting will cover a range of topics, including the vision that DHH has developed, health information technology, as well as the reform of our state's health care system.  How does the Affordable Care Act affect you as a provider?  What changes are being discussed in Louisiana's Medicaid program? What opportunities and incentives are there for practices with electronic medical records?  A series of briefings on these topics, followed by an open discussion and question-and-answer opportunity, will be offered. 

Basic Registration Instructions: There is no fee for registering for this event.  However, we ask that you complete the online registration form or submit the printable registration form to Karen Stassi by fax at 985.796.1672 or by e-mail at Karen.Stassi@la.gov. If you have questions, you may call Ms. Stassi at 225.342.3417.  In order to plan appropriately for refreshments, materials, etc. we ask that you return the completed registration form by Friday, Feb. 11. If you have questions about the meeting agenda or content, please contact Jimmy Guidry, M.D. at 225.342.3417 (phone), 225.342.4497 (fax) or e-mail jguidry@la.gov.

Our hope is to hold the Medical Directors' Summit annually to ensure we are keeping you informed of critical issues impacting Louisiana's providers and patients. We look forward to your participation.

Sincerely,

Bruce D. Greenstein             Jimmy Guidry, M.D.

Secretary                                 State Health Officer & Medical Director

In Case You Missed It: Statement from Louisiana Hospital Association

A statement from Louisiana Hospital Association President & CEO John Matessino was issued Friday, Feb. 4, regarding collaborative work with DHH on Medicaid reform efforts:

"While there is still work to be done, the LHA and its board support Governor Jindal's efforts for coordinating care through networks and continue to work with DHH and other health care providers on developing models that will best provide care for our most vulnerable patients, while recognizing and preserving the input and role of physicians and other health care professionals."

Letters in Support of Making Medicaid Better

The Department of Health & Hospitals has received letters of support for the proposal to implement Coordinated Care Networks (CCNs) in Medicaid from several health care organizations.  Learn more about CCNs and how these systems of care would better coordinate patients' treatment and services. Advocacy groups, physicians and medical professionals throughout the state have also written letters to the editor supporting the CCN model for Medicaid. See the letters of support online. 

Draft Notice of Intent and Related Materials

DHH has posted the Draft Notice of Intent as the proposed rule for implementing the CCN model and related materials online at www.MakingMedicaidBetter.com. Please visit the site to see the latest information. The department anticipates this notice will be published in the Louisiana Register on Feb. 20, 2011. This site will be updated frequently, and the public is advised to check here often for current details.

Featured Question

What is the state going to do to discourage Medicaid patients from using the ER for routine medical care and teach them to go to their primary care physician's office for basic treatment, prescriptions and testing or screening?

Curbing ER misuse and discouraging patients from seeking routine care in an ER are critical focuses of the state's proposed CCN model, as DHH realizes from ongoing discussions with providers and medical organizations that this issue severely impacts health care delivery and must be addressed through any changes to the Medicaid program.  

For emergency services providers, there are legal guidelines in place to assist in encouraging proper use of ER services among patients. Medicaid requires that all medically necessary services are provided. But, ER staff are not mandated under federal or state law to provide emergency care to treat individuals who come to the ER with non-emergent medical conditions. Federal law requires an appropriate screening exam with stabilization only if a patient does have an emergency health condition.  Staff are not obligated to perform extensive testing that isn't medically necessary.

Federal laws prevent DHH from punishing patients for inappropriate ER visits by imposing fines or co-payments, dropping their coverage or taking other measures that would cause a reduction in services.  But, the department is engaged in multiple initiatives to encourage patient responsibility and prevent ER misuse.

DHH is currently engaged in developing the CCNs systems of care to transform the Medicaid program from the current fee-for-service system, increasing access to and use of appropriate health services. These CCNs will be managed by organizations that have greater flexibility than the current Medicaid program to redirect resources toward enrollee education. A vital piece of CCN implementation will be extensive outreach to the Medicaid population. CCNs will work with primary care providers and other resources in their networks to encourage proper utilization of services and healthier choices among recipients.   

Because CCNs would assume some financial risk for escalating costs in Medicaid, it will be in their best interest to educate and incentivize Medicaid recipients in their network toward healthier outcomes such as proper use of services and obtaining primary and preventive care in the appropriate setting. For example, CCNs could increase the number of primary care visits a Medicaid recipient is allowed per year so the recipient isn't forced to use the emergency room for routine treatment. CCNs also could encourage doctors to provide extended and after-hours care, and could offer patients incentives for healthy choices (e.g. baby cribs or strollers for attending a specified number of well-baby visits, or a gift card to a local pharmacist for over-the-counter medications after complying with routine health screenings). These types of positive reinforcement incentives have proven very effective at changing recipients' behavior in other states that have implemented managed or coordinated care for their Medicaid population. The current Medicaid fee-for-service program is prohibited from offering such incentives.

While the state progresses toward the CCN model, recent enhancements to Medicaid's CommunityCARE program, which links the majority of Medicaid recipients to a primary care provider, are in place to curb ER misuse. The revised program includes pay-for-performance reimbursements that aim to reduce emergency room visits. Providers in the "CommunityCARE 2.0" program can earn incentive payments if they show a rate of low-level emergency room use among their patients (based on DHH claims data). An additional performance payment will be made for doctors who offer extended office hours (e.g. before 8 a.m. or after 5 p.m. Monday through Friday, or any time Saturday and Sunday), as this will help patients access care in an appropriate setting outside of their work hours and their children's school hours, rather than seeking after-hours treatment in the emergency room. Learn more about CommunityCARE 2.0 and the related pay-for-performance measures at http://www.la-communitycare.com.

Medical providers are encouraged to stay involved and offer their input on this and other issues through the process of implementing CCNs as DHH moves closer to the launch date (the current timeline has the first recipients enrolled in CCNs by January 2012). More information is available on the CCNs-focused Web site, www.MakingMedicaidBetter.com.

 Louisiana Medicaid EHR Incentive Program

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, which opened registration in January 2011, is offering payments to eligible providers and hospitals who treat Medicaid patients and wish to adopt this technology so they can better coordinate care. In the first month of the program, 18 providers and nine hospitals enrolled and earned more than $17 million overall in incentive payments. Program registration is open, and providers can learn more or sign up for the program 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.