Message from DHH Secretary Bruce D. Greenstein

Louisiana is on the verge of one of the most important health care reforms in our state's history. We all know the statistics -- a few weeks ago, the United Health Foundation reiterated the problem when they announced that Louisiana fell two spots to 49th in the annual America's Health Rankings. A major contributor to our dismal outcomes is a Medicaid program that fails to deliver good health outcomes despite costing a lot of taxpayer money. We have many great health care providers across the state, but we unfortunately have a system that is perfectly designed to deliver the results it does. When Governor Jindal took office, he set a clear agenda for reform.

Shortly after I came on board in September, I decided that I wanted to spend time hearing from providers and consumers across the state about their concerns with our proposed changes. So, we delayed implementation to give my team and me time to travel the state, meet with people who would be affected and get input on how we can most effectively transform our state's health care delivery system. Over the past month, we've held a series of nine meetings in all parts of the state, beginning with a forum Nov. 17 in Baton Rouge and ending with a forum Dec. 16 in New Orleans.

I wasn't sure what to expect going into these regional "Making Medicaid Better" forums, but they all were a valuable chance to listen to concerns and hear feedback and suggestions. We had great attendance statewide from patients, providers, health care organizations, advocates and other stakeholders, and several forums drew standing-room-only crowds. I was pleased to see so many around Louisiana take the time to attend these forums and get involved in this historic process to transform Medicaid.

I also was impressed with the insightful comments we received, many of which offered a unique perspective. For example, several parents of Medicaid recipients shared personal stories about the challenges they've faced getting health care for their children. This helps us better think through how we could improve access in a coordinated care network.

While guests at our forums had different ideas about how we could improve Medicaid, we all reached the same conclusion: our current system does not work. It's frustrating to me to see our failing health grades, and the forums showed that it's equally frustrating to the medical professionals around the state who work so hard to treat our patients.

At our final forum in New Orleans, we were privileged to have Thomas Johnson, president and CEO of Medicaid Health Plans of America, as a presenter. He described how coordinating care in Medicaid is a national trend other states have adopted to improve health outcomes. Johnson also shared encouraging stories about these programs' success in our peer states such as Tennessee and Kentucky, which saw improvements in health in a fairly short time after implementation. I firmly believe coordinating care in our Medicaid program is the right approach for Louisiana to take us off the predictable path to poor health we have been on for far too long, and we will use the feedback we've received at the forums to develop an approach that works best for our state, our citizens and our taxpayers. In fact, we've already announced several major changes to our proposal as a direct result of the feedback we've received.

Although the statewide forums have concluded, I hope you will stay involved. We have posted videos, presentations, FAQs and other materials from each forum at www.MakingMedicaidBetter.com. Visitors to the site can also submit comments or questions, and can sign up to receive our Making Medicaid Better newsletter. We update this site frequently and will continue doing so as our plan progresses, so I recommend you check here often for the latest information.

I cannot stress enough the urgency for implementing changes in our health care delivery. Like the rest of you, I am tired of seeing our state at the bottom of national lists. I know we can do better than maintaining the status quo. Our recipients, mostly children under age 21, deserve better health, and all our residents deserve more value for their tax dollars. We are one of the few states not coordinating care in Medicaid, and states that do are seeing tremendous improvements in health, while we remain in the bottom tier. It's time for all of us to work together and change this.

I am thankful to everyone who has contributed to the process thus far, and I hope to hear from even more of you as we work to make Medicaid better.

Sincerely,
Bruce D. Greenstein
Secretary, DHH

Featured Question
In the CCN model, could health entities administering care effectively monitor for fraud and abuse in the Medicaid program?

The majority of "fraud and abuse" incidents in Medicaid represent wasteful spending or negligent billing practices rather than criminal activities. For spending, because they assume the financial risk instead of taxpayers, CCNs have a huge incentive to reduce duplicative and unnecessary services and provide care in the most cost effective setting (e.g., the primary care provider's office or an urgent care center rather than a hospital emergency room). CCNs also have the financial resources to provide enrollee outreach and education, teaching them to use services in the most appropriate manner. For negligent billing, CCNs would have the resources to more effectively and efficiently monitor providers and remove those who abuse the Medicaid system. Also, in this model, the state still has the ultimate authority to authorize Medicaid health claims. CCNs' claims processes would be constantly monitored. Any systemic denial of patients' health care claims would be flagged as fraud.

Under the CCN model, DHH's Medicaid Program Integrity Unit will continue its relationship with the Attorney General's office and other law enforcement agencies to monitor and prosecute Medicaid fraud.  Citizens who suspect recipients or providers are abusing Medicaid can report fraud anonymously through the toll-free hotline, 1-800-488-2917, or by filling out the online reporting form.

Why Does Managing Care Matter?
FACT: The state recently received an 'F' in birth outcomes from the March of Dimes, for ranking poorly in premature births, infant mortality and low birth-weight babies. Medicaid pays for more than 70% of pregnancies and births in the state, and better prenatal care coordination could improve these rates.

At the New Orleans Area "Making Medicaid Better" forum, Thomas Johnson, Medicaid Health Plans of America, noted that South Carolina saw a 73% reduction in pre-term births after implementing a coordinated care plan.

See more facts about helping recipients at www.MakingMedicaidBetter.com.