Extent of Insurance Coverage Medicaid19.7% Uninsured20.2% Insured60.0% 912,000 uninsured (4th in...
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Transcript of Extent of Insurance Coverage Medicaid19.7% Uninsured20.2% Insured60.0% 912,000 uninsured (4th in...
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Charity Hospital
Extent of Insurance Coverage
MedicaidMedicaid19.7%19.7%
UninsuredUninsured20.2%20.2%
InsuredInsured60.0%60.0%
912,000 uninsured (4th in U.S.)912,000 uninsured (4th in U.S.)
891,000 Medicaid eligible891,000 Medicaid eligible
The healthcare of over 40% of Louisiana’s population is dependent on public funding
“Structured systems of care that link hospitals, clinics, and doctors together in an organized fashion, often represent the best hope to begin real programs of managing care, of disease management, and of quality and utilization control.”
-Governor’s Health Care Reform Panel Presentation, 12/16/04
James J. Mongan, MD President and CEO, Massachusetts General Hospital, Brigham and Womens Hospital,
The Harvard Hospitals, Boston
A Good ModelMulti-specialty Clinic System Linked with Hospitals
E. A. Conway Medical Center Monroe
Huey P Long Medical CenterPineville
W O Moss Regional Medical CenterLake Charles
University Medical Center
Lafayette
Earl K Long Medical Center
Baton Rouge
Lallie Kemp Regional Medical
CenterIndependence
Bogalusa Medical Center
Bogalusa
Medical Center of Louisiana atNew OrleansLeonard J. Chabert
Medical Center Houma
University Hospital
Shreveport
State Public Hospitals and ClinicsState Public Hospitals and Clinics
-Charity Hospital-University Hospital
Katrina
Rita
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2 Restore, Stabilize and RedistributeSpecialty Services
Envisioned System-wide Distribution of Specialty Services
Tertiary and Referral HospitalsMCLNO and Earl K. Long
Foundation HospitalsW. O Moss and Lallie Kemp
Secondary and Specialty HospitalsLeonard J. Chabert, University Medical Center, Bogalusa Medical Center, Huey P. Long
Mission-driven to care for the uninsured and provide Mission-driven to care for the uninsured and provide training opportunities for future health professionalstraining opportunities for future health professionals
A statewide Safety Net system in which everyone is A statewide Safety Net system in which everyone is eligible for careeligible for care No income thresholdsNo income thresholds No local residency requirementsNo local residency requirements No enrollment processNo enrollment process People with means expected to payPeople with means expected to pay
Provides comprehensive inpatient, outpatient Provides comprehensive inpatient, outpatient hospital and primary and specialty clinic serviceshospital and primary and specialty clinic services 350+ clinics350+ clinics Relies on medical residents for a substantial component of Relies on medical residents for a substantial component of
physician care as part of GME training programsphysician care as part of GME training programs
The LSU Hospitals and ClinicsIn Brief
LSU InitiativesDisease Management
Asthma
Diabetes
Congestive Heart Failure
HIV/AIDS
Cancer
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77BMC
92HPL
94UMC
98LJ C
95MCL
97EKL
Rank in USARank in LAScore
Median LA score = 89Median USA score = 91
Quality – Examples of ExcellenceLSU Hospital Ranking on Acute MI
5 Stars = Highest Quintile
Compliance With Recommended Treatments
USA Today, 9/06,Based on CMS Data
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RHCsaRHChs others
L-BMCFQHCs L-LAK L-EACL-SHR L-MCL
L-UMCL-HPLL-W OML-EKL
L-LJC
0
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1
Fra
ctio
n of
Pa
tient
s
Graph shows only PROVIDER GROUPS with 10+ patients
overall level = 44%, red = stat sig diff > .05 from overall levelsymbol size proportional to # of patients, range 36 to 9010
Mammogram in Past 2 Years, HEDIS , unadjusteddenom: HEDIS mammography, December 31, 2003
Quality – Examples of Excellence% With Mammogram in Past Two Y ears
Other MedicaidProviders
LSU Hospitals
The LSU Hospitals had a higher percentage of patients Receiving mammograms in the past two years, compared to Other Medicaid providers.
SOURCE: DHH
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Core Elements of LSU Health Care Vision
1 Rebuild and Improve I nfrastructure
2 Restore, Stabilize and Redistribute Specialty Services for a Dispersed Population Through a Multi-Hub Model
Extend Quality and Operational Improvement Strategies4
3 Disperse primary-care to sites close to the patient population
Prepare to Sustain Dual Mission in a Redesigned Health Care System5
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Expanded clinics providing primary care nearer patients
Stronger and closer relationships with community clinics and physicians, including electronic access to patient information
The concept of a “medical home” for every patient in the form of an appropriate physician to oversee all the patient’s care
Payment of physicians for care to the uninsured
Expanded coverage through Medicaid
5 Prepare for Health Care Redesign
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University HospitalUniversity HospitalPreliminary Clinic SitesPreliminary Clinic Sites
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22
33
44
CC
Proposed Clinic Sites
One remaining mobile clinic may serve as specialty care clinic at University Hospital
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77
88
Mobile Clinics1. Douglas Senior High
/Drew Elementary3820 St. Claude
2. Henderson Middle1912 L B Landry
3. Martin Behrman Elementary715 Opelousas
4. McDonough 28 Junior High2733 Esplanade
5. Jackson Barracks6. 1300 Myrtle Street -
Kenner (not shown)
Facility-Based Clinics7. O. Perry Walker
2832 General Meyer8. Oakwood
128 Wright
3 Decentralize Primary Care
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LSU/ VACollaborative Opportunities Study Group
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LSU and the VA - Natural Partners
Long history of collaboration through purchase of services
Both are public mission hospitals
Both provide more extensive outpatient than inpatient care
Both have integrated delivery systems with documented High Quality
Both had facilities effectively destroyed by Katrina
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The LSU/ VA Memorandum of Understanding
“…conduct an analysis to determine what, if any,mutually beneficial consolidation should occur between the New Orleans Veterans Affairs MedicalCenter (VAMC) and LSU-HCSD.”
Service, quality, access, cost, efficiency, management, practicality, legal and regulatory, logistics
Clinical areas Lab, Radiology Operating Rooms
Facility Sharing Parking Power Plant
Support Service Sharing Food service, Housekeeping Information Systems
Consider . . . .
Also. . .
Consider the alternative of developing nocooperative relationship with the VA.
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The Focus of the Collaborative Opportunities Study Group
Construction of a single campus Separate VA and LSU “towers” Shared functions, services, areas
Site in current medical district
Separate hospital identities maintained
“Sharing” defined by contractual relationships
Big Charity V.A. – New Orleans
A signature projectIn the recovery ofSouth Louisiana
The Charity Model
Louisiana needs all of its programs for the uninsured, and more are required as well. We don’t need to tear down systems of care that we have, but instead should find ways to secure and improve these systems and to supplement them with more.
A Principle for Reform