dumping patients – part 5

Happy New Year everyone! There is a saying that whatever one does on the first day of the new year, they will continue to do it thoroughout the remainder of the year – there was a cartoon about it this morning by Mutts. It might apply to blogging, although the time involved in investigation and producing quality posts is difficult to muster when one cannot do it as part of the work day. We’ll see…

The Washington D.C. Center on Budget and Policy Priorities wrote, In the Louisiana Health Care Reform Act of 2007, the Louisiana legislature put the state on a path intended to transform how Medicaid beneficiaries and low-income uninsured people get health care services. The Act directed the state Department of Health and Hospitals (DHH) to establish a “medical home system of care” with the goal of improving patient outcomes and increasing cost-effectiveness. In the medical home system envisioned by the Louisiana legislature, each individual would have a health care provider who would provide preventive and primary care and coordinate other care the individual may need from specialists and other health care providers.

So in this morning’s Times Picayune, there was a letter to the editor from Dr. Michael Fleming supporting the recent push in Louisiana for Medicaid reform.

Organization applauds state’s Medicaid reform
Posted by Letters to the Editor December 31, 2008 1:14PM

Re: “State’s Medicaid revamp clears Legislature, ” Page A2, Dec. 20. The Louisiana Health Care Quality Forum supports Medicaid reform in the state. The Quality Forum is a private, not-for-profit organization whose mission is to lead initiatives to improve the health of Louisiana.

The Quality Forum board has representatives from a statewide cross-section of major health care purchasers (such as employers), health plans, doctors and consumer advocates. We recognize that in order to achieve the quality of care that Louisiana citizens deserve, we need a fundamental redesign of the health care delivery system and payment structure.

The Quality Forum has been working to achieve this redesign through encouraging doctor acceptance of the patient-centered “medical home” concept. We are pleased that the Louisiana Health First reforms are rooted in this concept.

The Quality Forum believes the current transaction-based, volume-driven model of health care does not reward quality or provide accountability for care. Many of the strategies presented in the Louisiana Health First concept paper support the system redesign the Quality Forum promotes.

Still, much work remains on many of the details, including how to structure the networks, how to encourage doctor support, adoption of information technology, improving patient engagement in their own health and health care, doctor shortages and how to measure quality.

As planning takes place, the Quality Forum believes it is imperative that the Louisiana Department of Health and Hospitals continue to solicit input from all the stakeholders. We are committed to working with DHH in developing the plan and creating the system of quality health care that all Louisiana citizens deserve.

Michael Fleming, M.D.
Board of Directors
Louisiana Health Care Quality Forum
Baton Rouge

The Louisiana Health Care Quality Forum is based in Baton Rouge and appears to have a somewhat decent cross section of health care representation on its board – it is a private, not-for-profit organization. Dr. Fleming is directly involved in establishing policy via the LHCQF in tandem with the Center for Health Transformation. There are several representatives from the insurance industry on its board. One of the recent documents issued by the LHCQF is a drive to develop electronic medical records. Another PowerPoint from October 22, 2008 revealed that the LHCQF is associated with the Center for Health Transformation, whose executive director is Newt Gingrich. The most interesting frame on this website is the State Solutions section, where the primary focus on data is Health Justice – the connections between health care, medical insurance and legal litigation. There is health care reform and state medicaid information, however health justice is predominant.

Jindal and Gingrich appeared together on Face the Nation, November 16, 2008, and Jindal discussed his Republican Party talking points to a national audience. His reforms include the following: Number one, we’ve got to stop defending the kind of spending and out of control spending that we never have tolerated in the other side. You know, when voters tell us that they trust Democrats more to cut their taxes, control spending, that tells you something’s wrong with the Republican Party. We’ve got to match our actions with our rhetoric. Number two, we’ve got to stop defending the kinds of corruption we rightfully criticize in the other party. The week before the election our most senior senator is convicted on federal charges, and that’s only the latest example. Number three, we’ve got to be the party that offers real solutions to the problems that American voters, American families are worried about. We don’t need to abandon our onservative principles. We need–we can’t just be the party of no. We need to offer real solutions on making health care more affordable, on the economic challenges facing families, on the international threats.

As discussed in the October 22, 2008 Centers for Health Transformation event are Jindal’s current health care solutions: the reliance on private insurers to bear the burden of health care costs instead of a government payer system, preventative primary care, bariatric surgery for weight loss and diabetes prevention and electronic medical records. Compare this to the North Carolina model (3 links) that promotes the fact that health care for all people is a right. It does not take into consideration addressing bureaucratic and wasteful hospital structures, the behemoth of LSU with its lack of vision and collosal constraints, lack of health care workers and their education, pre-existing conditions and genetic diseases, the working poor, lack of a sufficient number of companies in the Louisiana insurance pool and continued research for current evidence-based practices.

Does this sound like enough to turn health care around in Louisiana, in the country? Its a start but there is much more needed, like direct involvement of all primary care providers and their support staff, with the emphasis on the care providers and not 3rd party reimbursement entities or medical businesses whose bottom lines are profit instead of the greater good of a healthy populus. Getting practitioners to buy into the medical home/outcomes based model will be a challenge. But with Louisiana dead last as unhealthiest state, health care policy must be comprehensive.

We’ll see if Jindal can get the feds to push his Medicaid model through before January 20, 2009 when Bush leaves. This definitely bears watching…

~ by maringouin on Thursday, January 1, 2009.

One Response to “dumping patients – part 5”

  1. nice article… thanks

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