Jeff Williams

A desire for more transparency led some of Louisiana’s major healthcare provider groups to support a bill that would have given legislators the power to end a new managed care program for the poor.

Although both houses of the Legislature passed the bill, Jindal vetoed the legislation. It’s unclear whether the transparency requirements or the legislative oversight provisions will be resurrected at a later session.

In a prepared statement, Jindal said a provision that allowed the Legislature to kill the program in 2014 and prevent the state from improving the outcomes in the Medicaid system sent “the wrong message.”

In a prepared statement, Jeff Williams, LSMS executive vice president, said the Medical Society was disappointed in the veto.

“The bill would have furthered good faith efforts at better reporting of healthcare quality and outcomes data as well as transparency in Louisiana’s healthcare system,” Williams said.

Both the Louisiana Hospital Association and the Louisiana State Medical Society steered clear of the debate on the bill’s sunset provisions.

Interviewed before the veto, LHA president and CEO, John Matessino, said the association really liked the bill because of the transparency amendments.

“We felt like it was important that the Coordinated Care Networks provide the kind of information to the public and to providers and everyone about the job that they’re doing, and the work that they’re doing,” Matessino said. “That was our reason for supporting the bill.”

Specifically the hospital association wanted more detail on each network’s claims, such as how many “clean claims” were coming in, how many claims were being paid and how many were being denied, Matessino said.

“When you get into the whole managed care activities, you want to make sure the clean claims are being paid and why claims are being denied,” he said. “That’s pretty much it in a nutshell.”

Under Jindal’s Coordinated Care Networks, private insurance companies or third-party administrators will eventually take over the care of two-thirds of the state’s Medicaid enrollment, mainly children and their mothers.

Insurers and third-party administrators will develop networks of doctors, hospitals and other providers. The idea is to improve care and lower costs by coordinating patients’ care.

 “I’m not sure it’s a bad idea to have the Legislature look at it, but I’ve got to believe if this program gets rolling – and we’ll see exactly how it does – but if it begins to get working, unless it’s a total failure I can’t imagine any legislative body overturning it,” Matessino said.

Dr. F. Dean Griffen, president of the Louisiana State Medical Society, said the group found itself in the middle of a battle between the state Department of Health and Hospitals and legislators who support the hospitals.

The hospitals need both as “cooperative co-conspirators” in order to provide the best care possible for Medicaid members, he said.

“So to that extent, it was a big deal for us to have to choose,” Griffen said.

The society supported the bill because the networks need to be monitored by outsiders to assure care remains as good or better than it has been in the past, Griffen said. In addition, the bill’s transparency provisions help assure doctors who will be needed to cover the CCNs, doctors already leery of DHH after seeing physicians’ Medicaid reimbursements drop by around 18 percent in the last two years.

These doctors already don’t want to take on new Medicaid patients because the physicians can’t afford to treat them, Griffen said. The society’s members are saying that reimbursements have fallen so much that doctors lose money every time they treat a Medicaid patient.

Into this climate, the Jindal administration is injecting a new system that looks, for all the world, like the managed care systems that totally failed in the 1980s, Griffen said. Those systems, pushed by the private sector, died because they were so underfunded that everyone went broke.

“Now they’re going to try it all again, run by the government,” Griffen said.

So LSMS supported Senate Bill 207 with its transparency and accountability requirements, Griffen said, if for no other reason that it will give doctors more confidence that the new system is working.

The more doctors who take part in Medicaid, the more people can be treated, Griffen said.

The Affordable Care Act is expected to boost the number of people eligible for Medicaid to as much as 58 percent of the state’s population by 2014, Griffen said. More doctors will be needed for those patients.

“We want more providers for Medicaid so that’s why we started out opposing this issue,” Griffen said.

LSMS changed its position after a sitdown with the governor, who told physicians that the networks were coming, and he wanted the doctors’ help to make them work, Griffen said. The society made recommendations and the Jindal administration has made some concessions relating to healthcare quality and patient services.

“So we’ll see how that goes,” Griffen said.

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