Dr. Rebekah Gee, secretary of the Louisiana Department of Health, addressess public health issues and health care spending at the Acadiana Culture of Health Summit at the University of Louisiana at Lafayette Student Union on Tuesday.

Louisiana’s top health official said 2019 will be the “year of public health,” with the state agency shifting its focus to “social determinants” like stress, housing, diet and other environmental factors to make people healthier and save money.

Speaking at the Acadiana Culture of Health Summit Tuesday, Dr. Rebekah Gee said Medicaid expansion, which has extended coverage to nearly a half-million Louisianians, has created a “blanket of coverage” throughout the state. Now, the Louisiana Department of Health is trying to make people healthier.

The state needs to focus on factors like race, stress, early childhood experience, housing, diet, smoking and others factors, Gee said. There’s “low-hanging fruit” outside the clinical care landscape, she added.

“Those things matter so much more than health care and yet we spend in our state $14 billion, and almost all of my spending is on health care and not public health,” Gee said. “We’re reimagining what public health looks like.”

For instance, Gee said treating a child with recurring asthma issues without treating the mold in the child’s home that causes it is wasting health care dollars. Initiatives could include coordinating with local organizations to provide healthier food options in schools and workplaces; using nontraditional strategies to identify people living with Hepatitis C; and investing in housing programs and infrastructure with an eye toward health.

The department is in the process of re-procuring Medicaid managed care, with a request for proposals likely to be issued early next year.

As part of that process, Gee said she hopes the companies providing services can put an increased focus on public health. A white paper issued earlier this year by her department said the next generation of managed-care contracts will require organizations to collect and analyze data to address health disparities and improve community collaboration, among other things.

Gee said the focus on public health initiatives likely will come without an increase in funding. Instead, the department will use “creativity and redirection” and existing dollars.

Gee also touted the success of the state’s Medicaid expansion, which has enrolled more than 480,000 people.

The department, which has been the center of a controversy over misspent Medicaid dollars, inherited an “onerous and complex” eligibility system, she added. State auditors earlier this year estimated the agency may have allowed up to $85 million to be misspent on ineligible people during a 20-month period.

Earlier this month, the department unveiled its new Medicaid enrollment system, which leaders said would address concerns over those potentially misspent funds. The $71 million effort was mostly covered by the federal government, and has been in the works for years.

Gee said while Louisiana has expanded access to health care and to treatment, health care costs remain a serious problem.

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Follow Sam Karlin on Twitter, @samkarlin.