Why Make Medicaid Better Now?Health Outcomes
Despite the best efforts of many dedicated health care professionals across Louisiana, the state continually places in the bottom tier of national health rankings. The rankings are particularly stark in the areas of primary and preventive care. Louisiana, for instance, has the highest infant mortality rate and ranks third highest in cancer deaths. The state's current system of care only perpetuates this problem, often rewarding quantity over quality. Providers are overwhelmed, recipients are often unable to find consistent health care, forcing too many to turn to costly emergency room visits, and chronic illnesses go undiagnosed and untreated until it's too late. An increased focus on coordination of care—particularly in primary, specialty and preventive care—is a necessary component to improving overall health outcomes for Louisiana residents.
Creating a coordinated care network will place less strain on the state budget as Louisiana's extremely high rates of avoidable hospital stays and readmissions are reduced. It will provide for a more financially sustainable system while improving health outcomes.
The Louisiana Legislature has taken several actions to transform Louisiana's Medicaid program. Through the Health Care Reform Act of 2007 and Act 1 of 2010, it tasked the Department of Health and Hospitals to create a new system of care. Following lawmakers' guidance, the department has developed the infrastructure for an evidence-based, quality-driven system that incorporates the use of the following:
* Health Information Technology
* Prepaid Reimbursement Methods
* Quality Measures
The legislative mandate that the system also be patient-centered and offer safe, accessible and sustainable health care for Medicaid recipients and low-income uninsured citizens has also been incorporated into this effort.
Fraud and Abuse
Nationwide, it is estimated that as much as 10 percent of Medicaid expenditures are wasted on fraud and abuse. Through overbilling, charging for products not delivered or various kickbacks and schemes, the impact to the Medicaid budget is staggering. In Louisiana, that 10 percent could translate to close to $700 million. Those lost millions could otherwise be used to expand eligibility or services, or improve reimbursement rates to providers.
The current Medicaid system leaves the taxpayers at risk for 100 percent of fraudulent payments. With the new system, the state will share this risk with the CCNs. These new networks will be responsible for performing their own fraud surveillance and having their own watchdog systems in place. And it will be in their best financial interest to be certain their system is effective.