Providers protest Medicaid revamp, cuts
Providers protest Medicaid revamp, cuts | Medicaid, managed care, coordinated care networks, Louisiana Ambulance Alliance, Louisiana Hospital Association, Louisiana State Medical Society, MedicineLouisiana, Metropolitan Hospital Council of New Orleans, Coalition to Protect Louisiana’s Healthcare, Department of Health and Hospitals, Bruce D. Greenstein

A coalition of healthcare providers is hoping to convince the Jindal administration to use federal stimulus funds to dollars to prevent crushing Medicaid healthcare cuts.

The coalition will have to overcome considerable resistance from the governor’s office. Department of Health and Hospitals secretary Bruce Greenstein has described the coalition’s suggestions as irresponsible and issued a statement to The Advocate newspaper saying the state had to prepare now because no one knows what will happen later this year.

The coalition issued a statement in response, saying members were disappointed in the DHH response to the proposals and “extremely troubled” by the department’s decision to cut $36 million for neonatal and pediatric intensive care hospital services in the Medicaid population.

“We urge the legislature to continue to work with us and others to protect these critical services,” the coalition said in statement.

Coalition members said they hope to discuss their ideas at a series of DHH meetings and with members of the state Legislature.

The coalition consists of the Louisiana Ambulance Alliance, Louisiana Hospital Association, Louisiana State Medical Society, MedicineLouisiana and the Metropolitan Hospital Council of New Orleans. The groups organized to protest the Jindal administration’s plan to direct Medicaid enrollees into private, managed-care plans.

The coalition worried that seven or eight insurance companies would end up pocketing 15 percent to 20 percent of $2 billion in Medicaid funding for administering the networks, said Dr. Patrick Breaux, State Medical Society president.

The coalition is working on an alternative coordinated-care model that the group says will put the patient first and lead to cost savings

The fight over healthcare dollars is taking place under the pressure of a state budget shortfall estimated at as much as $2 billion.

Community hospitals, physicians and emergency medical services had suffered more than $250 million in Medicaid cuts over the last two years, the coalition said. Those cuts were already hurting providers’ ability to care for patients and causing lasting harm to Louisiana communities and businesses.

DHH’s proposed cuts to the Medicaid program are “fiscally irresponsible and discriminatory to certain providers,” according to the coalition. The cuts will limit patients’ access to primary and specialty care, as well as hospital and emergency services.

“Slashing state funding for health care does four times as much damage, because we lose the ability to match millions of dollars of federal health care funding,” coalition members said in a joint statement.

However, Breaux said he and other coalition members were encouraged by delaying the coordinated care networks. He said coalition members hoped to use a series of DHH-organized forums on the Medicaid delivery system overhaul to rally support for their position.

Breaux said he’s optimistic that physicians and other coalition members will be able to work out a solution with Greenstein.

“I think we all want the same outcomes,” Breaux said.

The physicians, like Greenstein, want better healthcare quality and better value for all Louisiana citizens, particularly the Medicaid population, Breaux said.

“They’re the sickest and poorest. They receive by all measures poor care at increased cost compared to other states,” Breaux said.

The physicians and other coalition members know what the issues are, and coalition members want to change the situation, he said.

The situation, as laid out in DHH’s report “A Road Map for a Healthier Louisiana” is this:

The state spent $7.4 billion on healthcare in 2009 but squandered the opportunity to improve people’s health, the report says. The fragmented delivery system – almost exclusively fee-for-service – resulted in uneven quality of care, inequitable access to care and unpredictable costs.

The system was designed to provide episodic and acute care not to promote and maintain health, the report says. Louisiana has to move to a system of care that will improve health outcomes and move the state from its perpetual ranking at or near the bottom of the nation’s health rankings while dealing with multi-billion dollar budget shortfalls and government downsizing.

“The Institute of Medicine (of the National Academy of Sciences), says it best,” according to the report. “The current system cannot do the job. Trying harder will not work. Changing systems of care will.”

Considerable evidence shows that managed, coordinated care can improve health outcomes and lead to savings; in some cases, the savings can be 20 percent, the report shows.

In a prepared statement, Greenstein said Louisiana has been on the predictable path to poor health outcomes and high healthcare costs for too long.

“It’s a path that we follow, guided by systems that are inefficient at best, and broken, at worst,” Greenstein said. “Without change, it will only worsen.”

Breaux said the State Medical Society does not oppose a private solution to the Medicaid problem. In 1996, the society proposed a plan to allow Medicaid patients to buy health insurance policies with vouchers. In 2006, the society offered an updated version of the plan.

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