BATON ROUGE - The Louisiana Department of Health and Hospitals today announced that 12 entities have submitted proposals to become Coordinated Care Networks (CCN) in the state's Making Medicaid Better initiative. Of those 12, three have proposed to be a shared savings network and nine have proposed to be a pre-paid network.
"It is exciting to see so many entities interested in helping us improve health outcomes in Louisiana," said LDH Secretary Bruce D. Greenstein. "This competitive process will ensure that our evaluation teams can select those networks that have the best competencies to meaningfully impact our residents and transform our health system."
The CCNs chosen will be responsible for coordinating health care services for nearly 900,000 Medicaid recipients, including 80,000 adults with disabilities who do not receive Medicare. Prepaid CCNs will be risk-based and paid on a per month per member basis and will each be responsible for establishing a robust provider network of primary care physicians, specialists, hospitals and other providers, coordinating care for its members and for paying health care providers for services provided to its members.
Shared savings CCNs will have many of the same responsibilities for care coordination and improving clinical outcomes, but providers will continue to be paid on a fee-for-service basis by the state. These networks have the opportunity to share in the savings they generate by enhancing preventive care and disease management and reducing costs through better coordination of care and improved health outcomes.
For the purpose of implementing CCNs, the Department has divided the state into three geographical service areas (see map). Each GSA can have no more than three of each model of CCN operating in the area. Entities may operate in multiple GSAs.
The Department released the Request for Proposals for the networks on April 11 and received 1,003 written comments, which were posted online with the Department's responses at www.MakingMedicaidBetter.com prior to today's noon deadline for submitting proposals.
The following entities submitted proposals to be a Prepaid CCN:
Aetna Better Health Inc.
Amerigroup Louisiana Inc.
AmeriHealth Mercy of Louisiana Inc.
Children's Hospital Health Plan Inc.
Coventry Cares of Louisiana Inc.
Louisiana Cares Health Plan LLC
Louisiana Healthcare Connections Inc.
United Healthcare of Louisiana Inc.
Wellcare Health Plans Inc.
The following entities submitted proposals to be a Shared Savings CCN:
Community Health Solutions of America LLC
LA Physicians Connections LLC
United Healthcare of Louisiana Inc.
Each proposal will be carefully evaluated through a detailed evaluation process that begins with a basic review to ensure each meets the minimum requirements of the RFP. Once cleared for further evaluation, five teams will each review very specific aspects of each proposal and each team will meet independently to score their specific areas through a process of consensus scoring. The five teams are divided as follows:
- Team 1: Qualifications and Experience; Added Value to Louisiana
- Team 2: Planned Approach to Project; Provider Network; Fraud and Abuse
- Team 3: Member Enrollment and Disenrollment; Member Materials; Customer Service; Emergency Management Plan; Grievances and Appeals
- Team 4: Chronic Care/Disease Management; Service Coordination; Utilization Management; EPSDT; Quality Management
- Team 5: Third Party Liability (CCN-P only); Claims Management; Information Systems
The composition of the teams and the content of the proposals remain confidential during the evaluation process to protect the integrity of the evaluation process. Once the evaluation process is complete and scores are compiled, LDH will announce its recommendations for contract award on July 25. The Department is working closely with the Division of Administration, which must approve the evaluation process and the final contracts.
The first geographic service area is scheduled to go live on January 1, 2012 with each next GSA coming on line in 60-day increments following the first one.
More information on the Making Medicaid Better initiative is available at www.MakingMedicaidBetter.com.
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow LDH's blog, Twitter account and Facebook.