Gov. Bobby Jindal spent much of his first term getting the private sector more involved in solving the state’s health-care woes.
Through Jindal initiatives:
• The health care of more than 800,000 Medicaid recipients — mainly children and pregnant women — is scheduled to be turned over to private insurance companies in 2012.
• A private company is also set to take over management and coordination of behavioral health-care services for more than 150,000 Louisiana children and adults this spring.
• Under a public-private partnership, Our Lady of the Lake Regional Medical Center will become a home for LSU physician training and hospital care for the poor and uninsured. LSU’s antiquated hospital in north Baton Rouge will close by 2014.
• A state-of-the art $1 billion academic medical center is moving ahead in New Orleans, with a not-for-profit organization in charge of construction and facility management. It’s part of a larger medical complex that will include a Veterans Administration hospital.
“In each of these instances we are working in the private sector to adapt best practices to dramatically improve health outcomes in a shorter period of time,” Jindal said in an interview Wednesday.
As he campaigned in 2007, Jindal cited Louisiana’s ranking as the least healthy state by the United Health Foundation and talked about his plans to improve it.
Today, the same survey puts Louisiana at 49th, instead of 50th.
None of the major Jindal initiatives are operational as he ends his first term in office.
The first initiative to be launched is the one that has been the most controversial — relying on “coordinated care networks” established by insurance companies.
Under “coordinated care networks,” private insurers line up networks of physicians, hospitals and others to provide the care for two-thirds of the state’s 1.2 million people on Medicaid’s roll. Involved is more than $2 billion in Medicaid dollars. Five companies will get the business.
The program is set to begin in the New Orleans area in February, in the Baton Rouge area in April and statewide by June.
In addition, the governmental research group the Public Affairs Research Council has questioned whether it’s the right system for Louisiana.
Jindal said 36 other states have some kind of coordinated care, and are getting good results because of improved preventive and primary care. The state system is projected to save $136 million in its second year of implementation, he said.
“We will be paying for (health) outcomes instead of activity,” said Jindal, referring to Medicaid, which is now a “fee for service” system.
The concerns remain as the start date draws near and contract negotiations between the insurers and health-care providers are under way.
“We don’t have that warm, fuzzy feeling,” said Dr. Dean Griffen, a Shreveport surgeon and president of the Louisiana State Medical Society. “There are on-going concerns about the way it is coming down.”
Griffen said the current Medicaid system isn’t great but at least providers know what it is and isn’t.
PAR health-care analyst David Hood said Louisiana is “scraping bottom pretty much” when it comes to how much it pays providers who care for the targeted population.
Only 85 percent of the dollars insurers receive must be spent on health care while 15 percent is allowed for administration and company profits, said Hood, a former state health secretary.
“Is it possible for us to save money without limiting access and doing other things that might lower our ability to serve those lower-income people?” Hood said. “That’s what we are primarily worried about.”
But Jindal’s first health secretary, Alan Levine, under whose watch the “CCN” initiative moved forward, said critics should be looking down the road to 2014, when federal law changes will push hundreds of thousands more Louisiana residents into government-paid for health care.
“If Louisiana doesn’t do it (CCNs), and you add that number of people and you don’t have an organized delivery system, the state wouldn’t be able to handle it,” Levine said.
Meanwhile, the initiatives affecting LSU’s medical education and patient-care programs in Baton Rouge and New Orleans “are two game changers for us,” said Dr. Fred Cerise, an LSU System vice president over health care.
“Baton Rouge was a big deal for us, particularly when you look at what might be coming in 2014 with federal reform and the need for us to have a viable, strong in-patient facility for our training and patient care,” Cerise said.
“We can keep Baton Rouge as a real strong (physician) training outlet for us,” he said.
The public-private partnership between LSU and the Lake ended decades of indecision on what to do about antiquated conditions at LSU’s Earl K. Long, known as EKL, which threatened both hospital and teaching accreditation.
Jindal said the deal avoids spending $400 million on a new hospital that the state could not afford. The cooperative endeavor also will provide the Baton Rouge area with a Level 1 trauma center, which it is lacking today, he said.
Construction is under way on the Lake’s campus off Essen Lane to accommodate the new activity. Groundbreaking on an LSU medical education building is scheduled for summer 2012.
State Sen. Sharon Broome, D-Baton Rouge, in whose district EKL lies, said there are still loose ends to tie up, including federal approval needed to preserve funds for patient care through LSU’s Baton Rouge clinics.