Louisiana’s CommunityCARE program has been termed a “model of excellence” by the federal government following a recent review of the program that provides primary care for more than 600,000 Medicaid recipients.
The review was conducted in February 2005 and focused on the Department of Health and Hospitals’ oversight and monitoring of its contractors, providers, materials, procedures and contracts. In addition, beneficiaries, patient advocates and providers were interviewed about the program.
In its conclusion, the federal Centers for Medicare and Medicaid Services wrote, “The State should be very proud of the CommunityCARE program and its overall operation. It is apparent that the State’s dedication to providing the best health care available for recipients enrolled in CommunityCARE has resulted in a highly successful program that, in our opinion, is a ‘Model of Excellence’.”
There were no findings of deficiencies in the report. The only concern identified was the wording used in some marketing materials. This concern was addressed by the Department of Health and Hospitals, and revised materials will be submitted to the federal oversight agency as they are updated.
CommunityCARE is a comprehensive health delivery system in which Medicaid recipients are linked to a primary care physician. This doctor manages the care of each CommunityCARE enrollee by providing health education and preventive and acute care. The primary care physician also makes all referrals to specialists when needed.
In the 24 months between January 2002 and December 2003, Louisiana expanded CommunityCARE from only a few parishes to a comprehensive statewide program. The Centers for Medicare and Medicaid Services recognized this fast growth in its report.
“It is apparent the State strives to keep providers and recipients (informed) …,” CMS wrote in its review. “All this effort is especially commendable considering that CommunityCARE has grown exponentially during the past two years … the State has achieved excellent results with each phase in the expansion.”
Dr. Fred Cerise, LDH secretary, said a key strategy to improve health care quality is to reduce the number of Medicaid patients who use emergency rooms inappropriately by linking them to a primary care physician.
“With this in mind, we are extremely pleased that our innovative CommunityCARE program has received national recognition as a model of excellence,” he stated.