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Louisiana Health Care Quality Forum

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    1. Karen DeSalvo, MD, MPH, MSc Tulane University Chair, Medical Home Committee

    3. Critical Questions Why does the Patient-Centered Medical Home matter for Louisiana? What demonstrations are underway? What is on the horizon?

    4. 4

    5. 5 But poor quality for this. In fact, in US, have a 50/50 chance of getting evidence-based health care you need.But poor quality for this. In fact, in US, have a 50/50 chance of getting evidence-based health care you need.

    6. Quality & Spending in Louisiana 6 Source: Health Dialog, 2007; Data from 2005; www.lhcqf.org Higher costs do not appear to correlate with low gap scores (high quality) Gap scores represent aggregation of quality metrics, lower gap score=higher quality Diamonds represent Louisiana Hospital Services Areas (HSAs) with = 10,000 people

    7. Lack of Primary Care Providers 7

    8. Our Opportunity from Tragedy

    9. Louisiana Healthcare Redesign 9 Legend Overlapping circles indicate significant overlap of participants between planning groups. Produced the Framework for a Healthier New Orleans (November 2005) which focused on realigning the health system to emphasize evidence-based, cost-effective prevention and primary care. The LHA produced a policy statement with assistance of the Lewin Group (January 2006) which focused on short term solutions. Patients First was a consortium of the Framework Group, BC/BS, Louisiana Business Association and the Louisiana Hospital Association (LHA). Focused on synthesizing recommendations of all reports. Built upon the Framework document. Bring New Orleans Back Health and Social Services Committee released report January 2006. Focused on reducing system redundancy and models of delivery to enable prevention and primary care. A pre-Katrina entity that is developing a long range plan focused on the public system. The LRA will develop an initial report by April 2006 building upon the concepts from these other planning groups and focus on financing, delivery and implementation. Legend Overlapping circles indicate significant overlap of participants between planning groups. Produced the Framework for a Healthier New Orleans (November 2005) which focused on realigning the health system to emphasize evidence-based, cost-effective prevention and primary care. The LHA produced a policy statement with assistance of the Lewin Group (January 2006) which focused on short term solutions. Patients First was a consortium of the Framework Group, BC/BS, Louisiana Business Association and the Louisiana Hospital Association (LHA). Focused on synthesizing recommendations of all reports. Built upon the Framework document. Bring New Orleans Back Health and Social Services Committee released report January 2006. Focused on reducing system redundancy and models of delivery to enable prevention and primary care. A pre-Katrina entity that is developing a long range plan focused on the public system. The LRA will develop an initial report by April 2006 building upon the concepts from these other planning groups and focus on financing, delivery and implementation.

    10. Major Reform Recommendations LA Health Care Redesign Collaborative Expanding choice and access ? Connector/Medicaid Supporting care ?health information technology Ensuring quality ? Louisiana Quality Forum Improving delivery ? Focus on Primary Care

    11. Major Reform Progress LA Health Care Redesign Collaborative Expanding choice and access ? Connector/Medicaid Supporting care ?health information technology Ensuring quality ? Louisiana Quality Forum Improving delivery ? Focus on Medical Home

    12. Louisiana Healthcare Redesign 12 Legend Overlapping circles indicate significant overlap of participants between planning groups. Produced the Framework for a Healthier New Orleans (November 2005) which focused on realigning the health system to emphasize evidence-based, cost-effective prevention and primary care. The LHA produced a policy statement with assistance of the Lewin Group (January 2006) which focused on short term solutions. Patients First was a consortium of the Framework Group, BC/BS, Louisiana Business Association and the Louisiana Hospital Association (LHA). Focused on synthesizing recommendations of all reports. Built upon the Framework document. Bring New Orleans Back Health and Social Services Committee released report January 2006. Focused on reducing system redundancy and models of delivery to enable prevention and primary care. A pre-Katrina entity that is developing a long range plan focused on the public system. The LRA will develop an initial report by April 2006 building upon the concepts from these other planning groups and focus on financing, delivery and implementation. Legend Overlapping circles indicate significant overlap of participants between planning groups. Produced the Framework for a Healthier New Orleans (November 2005) which focused on realigning the health system to emphasize evidence-based, cost-effective prevention and primary care. The LHA produced a policy statement with assistance of the Lewin Group (January 2006) which focused on short term solutions. Patients First was a consortium of the Framework Group, BC/BS, Louisiana Business Association and the Louisiana Hospital Association (LHA). Focused on synthesizing recommendations of all reports. Built upon the Framework document. Bring New Orleans Back Health and Social Services Committee released report January 2006. Focused on reducing system redundancy and models of delivery to enable prevention and primary care. A pre-Katrina entity that is developing a long range plan focused on the public system. The LRA will develop an initial report by April 2006 building upon the concepts from these other planning groups and focus on financing, delivery and implementation.

    13. Medical Home Committee 13 Convene the states major healthcare stakeholdersfor the purpose of developing and accelerating the adoption of standard components and criteria for the delivery of health care services via the patient-centered medical home

    14. LA Medical Home Committee 14 15 committee members Broad-based and balanced representation Across the state, rural and urban providers Skills or experience in one or more of the following categories: Operational and Clinical Requirements Practice Management Consumer/Patient Advocacy Quality Measurement and Evaluation Quality Improvement Policy and Legal Affairs Payers (Medicaid, Medicare, Private)

    15. MHC Strategic Goals Implement Patient-Centered Medical Home Learning collaborative Shape the Medical Home Systems of Care Implement Medical Home Systems of Care demonstrations Begin an environmental scan of potential barriers to implementation of the patient centered medical home and medical home system of care in Louisiana

    16. Medical Home in Louisiana 16 Louisiana has embraced the national definition of a medical home Joint Principles NCQA criteria

    17. Critical Questions Why does the Patient-Centered Medical Home matter for Louisiana? What demonstrations are underway? What is on the horizon?

    18. LA Medical Home Projects Rural initiative in North Louisiana Franciscan Missionaries of Our Lady New Orleans Medicaid Provider Service Networks

    19. 19

    20. Board of the Medical Home Task Force in Region VII Implement NCQA guidelines at local clinics David Raines Community Health Center North Caddo Medical Center Christus Schumpert Coushatta Plain Dealing Martin Luther King Health Center Pool of Siloam Medical Ministry and Free Clinic Funded through HHS Evaluation Implementation of EHR, NCQA certification School performance 20

    21. Franciscan Missionaries of Our Lady Health System Non-profit statewide organization Focus on St. Bernard Parish Model Franciscan Quality Trustee the Medical Home a Defined Population Internal funding with discussions to expand 21 A patient-centric Medical Home will proactively provide care for every member of the Defined Population and a Franciscan Quality Trustee will serve as a resource to the medical home to support quality, safety, and transparency in the system. The Pilot will be consistent with the Institute of Medicines six aims and is expected to result in healthcare that adds measurable value by producing the best possible health outcomes through appropriate care processes at an affordable cost. The opportunity for cultural change in the delivery of healthcare is dependent on three fundamentals: Coordinating well-care and sick-care from the Medical Home through the use of evidence-based processes with a focus on good health outcomes and high patient satisfaction Realigning the incentives for all stakeholders to prioritize preventive care, healthy lifestyles, and quality healthcare rather than production Using technology to enable a data-driven environment for quality measurement and value improvement A patient-centric Medical Home will proactively provide care for every member of the Defined Population and a Franciscan Quality Trustee will serve as a resource to the medical home to support quality, safety, and transparency in the system. The Pilot will be consistent with the Institute of Medicines six aims and is expected to result in healthcare that adds measurable value by producing the best possible health outcomes through appropriate care processes at an affordable cost. The opportunity for cultural change in the delivery of healthcare is dependent on three fundamentals: Coordinating well-care and sick-care from the Medical Home through the use of evidence-based processes with a focus on good health outcomes and high patient satisfaction Realigning the incentives for all stakeholders to prioritize preventive care, healthy lifestyles, and quality healthcare rather than production Using technology to enable a data-driven environment for quality measurement and value improvement

    22. Primary Care Access Stabilization Grant 22 Build upon chassis of temporary care sites still active since recovery Philanthropy has allowed flexible structure of care Team care, Information technology, mental health Post-Katrina assistance Congressional hearing $100 million from HHS in 5/07 Build provider network of neighborhood based care Pay for performance for medical home certification

    23. PCASG Grantee Meeting January 17, 2008

    24. Tulane Community Health Center at Covenant House from ice chest to medical home 24 Discuss our certification processDiscuss our certification process

    25. Results to date 17 funded primary care entities working together Build fabric of the new system in New Orleans Wide range in scope and size Some advancing in to medical homes 80,000 people served increase in 10% of those served $43 million distributed 12 of 17 organizations working towards MH certification 21% increase in citizens with usual source of care other than emergency rooms in past 2 years* 25

    26. Medicaid Medical Home Louisiana Health Care Reform Act 2007 Called for Louisiana Health First The medical home system of care shall incorporate the use of health information technology and quality measures to facilitate a safe, patient-centered, quality driven, evidence-based, accessible, and sustainable health care system to Medicaid recipients and low-income uninsured citizens. 26

    27. Provider Service Network = Medical Home System of Care At least 25% ownership by a hospital and/or provider group Pilot in 4 regions of the state Mandatory enrollment Potential coverage expansion Medicaid and connector All providers must move towards NCQA certification as a medical home 27

    28. 28

    29. Medical Home Implementation in New Orleans 29 Build upon chassis of temporary care sites still active since recovery Integrate mental services Philanthropy has allowed flexible structure of care Team care, Information technology, mental health Advocacy win Congressional hearing $100 million from HHS (5/07) Build provider network of neighborhood based care

    30. 30 Primary care OB, Mental Health Some prevention (womens health) Scant specialty services Laboratory and diagnostics 30% of clinics with EHR Presently serving 103,000 people 50% with some sort of insurance coverage 2/3 of the uninsured population of 80,000 Primary care OB, Mental Health Some prevention (womens health) Scant specialty services Laboratory and diagnostics 30% of clinics with EHR Presently serving 103,000 people 50% with some sort of insurance coverage 2/3 of the uninsured population of 80,000

    31. Results to date 17 funded primary care entities working together Build fabric of the new system in New Orleans Wide range in scope and size Some advancing in to medical homes Highest density of certified medical homes in US Winter 2009 21% increase in citizens with usual source of care other than emergency rooms in past 2 years* 31

    32. Critical Questions Why does the Patient-Centered Medical Home matter for Louisiana? What demonstrations are underway? What is on the horizon?

    33. Health is More than Getting People to a Doctor Social homeSocial home

    34. Social/Mental Determinants of Health Heavy burden of stress and mental health issues 31% report mental health problems 39% worse mental health since Katrina 53% with higher general stress level Increased PTSD associated with lack of adequate housing Adjusted OR 2.0 (1.2-3.5) Lack of social support associated with for cutting back on chronic care treatment Adjusted OR 15.0 (3.859.4)

    35. Community Oriented Primary Care Systematic approach to health care based upon: Epidemiology Primary care Preventive medicine Health promotion Includes interventions for individuals and population at large Providers play multiple roles Community involved in decisions

    36. Neighborhood Centers

    37. Thank you.