Overview of Vision and Needs for Louisiana Healthcare
The devastation of the Gulf Coast by Hurricane Katrina provided an unprecedented opportunity to rebuild the health sector of a major American city long overdue for modernization. Stakeholders have called for a redesigned system which will be a patient-centered, quality-driven, sustainable and accessible to all citizens.
Any health care redesign should be grounded in the following major principles:
1. Quality, value and transparency
2. Efficient use of existing resources
3. Consumer choice
4. Engagement of Consumers and Community
5. Aligned incentives for improved outcomes
6. Access to a modernized safety-net
7. Maximizing affordable coverage options
8. Portability of benefits
9. Evidenced-based planning & evaluation
10. Exemplary yet flexible training of health professionals
Health care redesign in post-hurricane Louisiana culminated in the work of the 40 member, multi-stakeholder Louisiana Health Care Redesign Collaborative (the Collaborative) in 2006. This group, working in partnership with Department of Health and Human Services (HHS) Secretary Michael Leavitt, sought to redesign both the financing and delivery of the health sector to create one that was more patient centered and of higher value.
The Collaborative arrived at four major recommendations for health sector redesign in Louisiana which included:
1. Expansion of access to affordable health care coverage;
2. Implementation of medical home systems of care;
3. The use of health information technology to support patients and providers; and
4. Establishment of shared quality standards and information.
Efforts at health sector rebuilding and redesign have centered on implementing these recommendations.
Working together the community, state and federal governments have made progress in implementing these recommendations for redesign including:
1. Expansion of access to affordable health care coverage
a. Expansion of LaCHIP eligibility to provide coverage for more low income children;
2. Implementation of the Medical Home System of Care
a. Developed medical home capacity in Greater New Orleans through the allocation of $100 million in May 2007 for the Primary Care Access and Stabilization Grant;
b. Supported the recruitment and retention of primary care and mental health workers through $50 million in support from HHS for the Greater New Orleans Health Service Corps;
c. Federal Emergency Room Diversion Grant to support after hours care; and
d. The designation of an additional Federally Qualified Health Center license to the Greater New Orleans area.
3. Health Information Technology
a. The award of a CMS Electronic Health Record Demonstration grant to increase the adoption of technology by private practices; and
b. State allocation of $13 million for interoperability programs and
the implementation of electronic medical records by Medicaid
4. Establishment of Quality Standards and Information
a. The passage of the Consumer's Right to Know Act by the Legislature; and
b. The creation of the Louisiana Health Care Quality Forum and its designation as a Chartered Value Exchange by HHS.
Despite this progress, significant challenges remain that require
consensus. These major issues include:
1. The plan for Medical Center of Louisiana at New Orleans (MCLNO), a major health professional training site and cornerstone of the safety-net;
2. The optimal relationship between the new MCLNO and the Veteran's Administration Hospital;
3. A plan or sustainability of the safety-net clinics developed through the Primary Care Access and Stabilization Grant;
4. Expansion of affordable health insurance coverage to adults; and
5. A long term solution for graduate medical education.
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