Bayou Health Plans Earn High Marks from External Review

An External Quality Review Organization says Bayou Health Plans are 98 percent in compliance with state and federal regulations

Thursday, Dec. 19, 2013  |  Contact: Olivia Watkins (225)610-8660; olivia.w@la.gov

Baton Rouge, La. - The Department of Health and Hospitals released today final External Quality Review Organization (EQRO) reports  that show that the Bayou Health Plans collectively earned high marks for compliance with more than 4,000 state and federal requirements. Compliance with requirements from the U.S. Centers for Medicare and Medicaid Services is key to demonstrating that they Bayou Health Plans are effectively managing the health care of the more than 900,000 individuals enrolled in the State's Medicaid managed care program. This is the first EQRO report to be issued for Bayou Health, which was implemented in by the Department of Health and Hospitals in 2012. 

"This external review of Bayou Health is further evidence that the transformation of Louisiana's Medicaid program is effective both for those individuals it serves and also for the health care providers across the state," DHH Secretary Kathy Kliebert said. "Bayou Health has dramatically increased access to new resources that better promote coordination of care and management of chronic diseases. This external review is an important indicator that what we're doing works and it is an important tool for us to use as we work to continually improve service to our members."

The External Quality Review (EQR) is conducted by an independent third-party to analyze and evaluate the collected information on quality, timeliness and access to health care services of a managed care organization to its Medicaid recipients. An EQRO must be conducted by an organization with staff that has a demonstrated knowledge and experience with Medicaid recipients, policies, data systems and processes, and with managed care delivery systems, organizations and financing, as well as quality assessment and improvement methods. The EQR staff must also have demonstrated skill with research design and methodology, and with statistical analysis. IPRO was the EQRO that conducted the review of the Bayou Health Plans. The review covered February 2012 through June 30, 2013.

"We actively manage and monitor the health plans through regular meetings with leadership from each of the plans and through quarterly business reviews of their management of Medicaid services," said DHH Undersecretary Jerry Phillips. "This external report helps to confirm that our method of managing and tracking the progress of our Medicaid contractors, for Bayou Health and other programs, is working. We will continue to -set high expectations for our health plan partners to improve care, but I am very pleased with what the external review shows us."

Each of the five Bayou Health Plans was reviewed separately by the EQRO. Their individual requirements and scores are as follows:

• Amerigroup - 899 requirements with a 98 percent full and substantial compliance
• LaCare - 899 requirements with a 98 percent full and substantial compliance
• Louisiana Healthcare Connections - 899 requirements with a 98 percent full and substantial compliance
• Community Health Solutions of Louisiana - 740 requirements with a 96 percent full and substantial compliance
• UnitedHealthcare Community Plan of Louisiana - 740 requirements with a 99 percent full and substantial compliance. 

The reports are posted online at MakingMedicaidBetter.com. DHH also tracks and publishes reports on numerous other administrative measures that are available on its Bayou Health "reporting and accountability" portal at MakingMedicaidBetter.com.

Bayou Health empowers Medicaid recipients to choose a Health Plan to fit their needs from a group of five different plans. In addition to the evidence of contractual and regulatory compliance demonstrated by the EQR report, DHH has observed tremendous improvements in the quality of care delivered under Bayou Health. Over the course of the first year of implementation of the Bayou Health program, there were numerous noteworthy accomplishments, including:

• Claims data indicates a significant reduction in statewide neonatal intensive care unit (NICU) days paid by Medicaid, meaning more babies were carried full-term.
• The overall collective physician oversight for enrollees increased five-fold and tremendous new care management resources were offered to recipients.
• More than 25,000 individuals received case management to help them better manage their chronic or high-risk health conditions. 
• Health Plans provided support for more than 63,000 members in their efforts to quit smoking, lose weight, gain access to dental and vision services and to purchase medical essentials such as prescription medications, child care supplies and more. 
• Health plans are assisting at least 111 practices with ongoing Patient Centered Medical Home (PCMH) certification, with six having obtained initial or higher level recognition. 

The Louisiana Department of Health and Hospitals 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 DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's Twitter account and Facebook.

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