La. Officials Hope to Create ‘Medical Homes’ for Poor, Uninsured

A proposed health care overhaul in the New Orleans area after Hurricane Katrina centers on the creation of “medical homes” – community clinics, health centers and other neighborhood facilities to coordinate care for those who depend on the state for services.

The “medical homes” would refer patients to specialists, manage disease care and provide a consistent system for tracking care that officials hope will provide better and cheaper care to the poor and uninsured with the pool of state and federal dollars available to Louisiana.

Patients could avoid redundant testing, could treat preventive illnesses earlier and wouldn’t turn to expensive emergency rooms for care that could be provided elsewhere, said Fred Cerise, the head of Louisiana’s health department.

“We need to move from this current state where we’ve got unconnected silos of care,” Cerise, secretary of the Louisiana Department of Health and Hospitals, told a panel of the Louisiana Recovery Authority.

However, Cerise said the details of how private providers and the LSU-run charity hospital system would fit into that model still are being developed, a crucial detail to be determined before formal health care redesign plans are submitted to federal officials in October.

U.S. Health and Human Services Secretary Mike Leavitt is working with state officials on a comprehensive revamp of the health care system in Orleans, Jefferson, St. Bernard and Plaquemines parishes – parishes hardest-hit by Katrina.

In the area, many hospitals, clinics and doctor’s offices were flooded and remain shuttered, further battering an already fragmented system of care in which the poor and uninsured depended on the charity hospitals and insured patients relied on private providers.

Leavitt, who holds the purse strings for many of the dollars Louisiana spends on health care and who can waive regulations needed to reorganize that spending, says the storm provided an opportunity for the area to improve its health care services and become a national model.

A 40-member group called the Louisiana Health Care Redesign Collaborative, set up by the state Legislature, is working on the design of the health care restructuring. The collaborative is slated to give a blueprint by Oct. 20 to Leavitt’s office.

But Sonia Madison, Leavitt’s representative who is working with Louisiana officials on the redesign, said there have been difficulties coordinating with a group that includes 40 members. She said Leavitt suggested a smaller group of five or seven members of the health care collaborative work on the final revamp and then present it to the full group.

“Let’s get a plan on the table because Oct. 20 will be here very soon,” Madison said.

Leavitt has agreed to provide flexibility with the federal health care dollars Louisiana receives but has asked the state to develop a plan that redirects current dollars, not asks for new federal cash.

Fifty-one percent of all the health care dollars spent in Louisiana are spent on public health care programs for the uninsured and for the poor, elderly and disabled in Medicaid and Medicare programs.

Cerise said a prototype computerized health information exchange would be running in New Orleans by the end of next month to let major health care providers share information on patient diagnoses, lab results and other medial records. He said providers have agreed to the patient tracking system that lets different computer systems share information.

Cerise said the “medical home” facilities would probably be a combination of existing clinics and health centers and new ones for neighborhoods where medical offices were washed away by Katrina or were inadequate even before the storm.