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Act 243 of the 2007 Regular Legislative Session, known as the Health Care Reform Act of 2007, directed the state to develop and implement a medical home system of care called Louisiana Health First. The law further stipulated that the medical home system incorporate health information technology (HIT) and quality measures to increase access, improve quality, and provide sustainability in medical care for the Medicaid and low-income uninsured populations.  However, the Centers for Medicare & Medicaid Services (CMS) did not approve the Louisiana Health First Section 1115 waiver required to implement the program. Act 243 of the 2007 Regular Legislative Session required the Louisiana Department of Health and Hospitals (DHH) to implement the legislation as feasible if CMS did not approve the waiver.
 
In April 2011, DHH released two requests for proposals (RFPs) to implement Bayou Health, a redesign of CommunityCare, Louisiana Medicaid’s primary care case management program. DHH anticipates that Bayou Health participants will have access to a medical home, and the networks are required to support and facilitate medical home recognition and/or accreditation. The state rolled out Bayou Health across the state’s three geographical service areas in February, April, and June 2012; the program was implemented statewide as of June 1st, 2012.
 
Federal Support:
  • In 2007, the United States Department of Health and Human Services awarded Louisiana a $100 million Primary Care Access and Stabilization Grant (PCASG) to rebuild the greater New Orleans area’s primary care system after Hurricane Katrina. The state provided PCASG funds to 25 outpatient provider organizations. Louisiana used the PCASG as an opportunity to build a foundation for medical homes. Indeed, the Louisiana Public Health Institute (LPHI) notes that the PCASG resulted in 36 sites receiving NQCA medical home recognition
  • The Crescent City Beacon Community serves the Greater New Orleans area.
Last Updated: April 2014
 
Forming Partnerships
The Louisiana legislature established the Louisiana Health Care Quality Forum (LHCQF) with House Concurrent Resolution 75 of the 2007 Regular Legislative Session. LHCQF was established to convene all public and private stakeholders to advance quality initiatives in the state, including the medical home. In March 2008, LHCQF held a medical home summit.
Defining & Recognizing a Medical Home
Definition: Act 243 of the 2007 Regular Legislative Session defined a medical home system as: “a health care delivery system that is patient and family centered and is guided by a personal primary care provider who coordinates and facilitates preventive and primary care that improves patient outcomes in the most cost-efficient manner possible. By providing a coordinated continuum of care, the cost of the current health care delivery system shall be reduced, health outcomes shall improve, and the disparities in access to health care among the state's populations shall be reduced. The medical home system of care shall consist of an integrated system of public, private, or public and private primary care providers, specialty care groups, and hospital providers that are willing to participate in the integrated system and meet participation criteria.”
 
In 2008, the Louisiana Health Care Quality Forum’s Board of Directors defined a medical home using an abridged version of the Joint Principles of the Patient-Centered Medical Home: “An approach to providing comprehensive primary care that facilitates partnerships between individual patients, and their personal physicians, and when appropriate the patient’s family.” It is important to note that the Louisiana Health Care Quality Forum stressed that (1) there are times when a medical home need not be physician-led and (2) medical homes should not be restricted to one particular degree or license.
 
Another definition was included in the 2011 Bayou Health Request for Proposals (RFPs): “Systems of care led by a team of primary care providers who partner with the patient, the patient’s family and the community to coordinate care in all settings, from specialists and hospitals to pharmacies, nursing homes and home health agencies. Primary care providers are inclusive of physician-led and nurse-practitioner-led primary care practices.”
 
Recognition: The Louisiana Health Care Quality Forum’s spring 2008 report notes that the Forum’s Board of Directors endorsed the 2008 NCQA PCMH standards
 
As part of the Bayou Health RFPs, care coordination networks are required to promote and facilitate NCQA recognition or Joint Commission (JC) Primary Care Medical Home accreditation. 
 
Networks must meet the following thresholds:
  • End of Year 1: 20% of practices must be NCQA Level 1 recognized or JC accredited;
  • End of Year 2: 30% of practices must be NCQA Level 1 recognized or JC accredited, and 10% of practices must be NCQA Level 2 recognized or JC accredited;
  • End of Year 3: 10% of practices must be NCQA Level 1 recognized or JC accredited; 40% of practices must be NCQA Level 2 recognized or JC accredited, and 10% of practices must be Level 3 recognized or JC accredited.
  • Subsequent Contracts: 80% of practices must receive NCQA recognition or JC accreditation.
Aligning Reimbursement & Purchasing
Under Bayou Health, the Louisiana Department of Health and Hospitals (DHH) is simultaneously implementing two separate models:
  1. Prepaid: Three managed care plans (Amerigroup Louisiana, Inc., Amerihealth Mercy of Louisiana, Inc. and Louisiana Healthcare Connections, Inc.) receive monthly risk-adjusted capitated payments. These plans also receive a lump sum maternity payment for each obstetrical delivery to cover the cost of prenatal and post-partum costs, as well as the delivery and normal newborn hospital costs. The networks are liable for 100% of any costs above the capitation rate. For more information on the reimbursement model or risk-adjustment methodology, please see the Request for Proposal.
  2. Shared Savings: Two managed care plans (Community Health Solutions, Inc. and United Healthcare of Louisiana) receive per-member per-month (PMPM) enhanced primary care case management fees and, if earned, lump sum shared savings payments. For more information, please see the Request for Proposal. The networks are required to pay a portion of their case management fees to primary care providers as a PMPM care coordination payment. Up to 50 percent of the network’s case management fee is subject to repayment to the state if the predetermined savings benchmark is not met.
Both RFPs allow networks to develop performance-based physician incentive plans.
Supporting Practices
The Louisiana Health Care Quality Forum (LHCQF) developed a patient-centered medical home (PCMH) toolkit as a resource for providers.  As a Regional Extension Center, LHCQF is currently providing health information technology technical assistance.
 
Bayou Health care coordination networks are required to develop a PCMH Implementation Plan, which includes a description of the technical assistance that the networks will provide to primary care physicians to support practice transformation and national recognition/accreditation. Technical assistance activities will vary across networks. The networks are required to participate in Patient-Centered Primary Care Collaborative activities.
Measuring Results
Beginning in calendar year 2013, Bayou Health networks are required to report clinical and administrative performance data annually.
 
Required data will include measures from the following sources:
  • Healthcare Effectiveness Data and Information Set (HEDIS);
  • Agency for Healthcare Research and Quality Review (AHRQ);
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS);
  • Children's Health Insurance Program Reauthorization Act (CHIPRA); and
  • Other measures as determined by the Louisiana Department of Health and Hospitals.
For specific measures, please see the networks’ quality companion guide or the appendices for the prepaid and shared savings request for proposals.

 

 

 

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