LIVE from HIMSS17: How Louisiana Healthcare Leaders Collaborated to Reduce ED Over-Utilization | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

LIVE from HIMSS17: How Louisiana Healthcare Leaders Collaborated to Reduce ED Over-Utilization

February 19, 2017
by Mark Hagland
| Reprints
A statewide collaboration around excessive ED utilization is showing big results in Louisiana

Sunday’s day of Pre-Conference Symposia at HIMSS17 on Feb. 19 in Orlando offered a very wide range of sessions geared towards every constituency group in healthcare and healthcare IT, among them physician leaders, nurse leaders, and those involved in creating the future around population health management, payer-provider collaboration, precision medicine, artificial intelligence, patient engagement, interoperability, medical device management, cybersecurity, and other important topics.

When it comes to successful payer-provider collaboration around care and cost management, the final session in the Population Care Management Symposium offered much for the senior leaders of all stakeholder groups in healthcare—providers, payers, government agencies, and non-governmental, quality-focused organizations—to ponder. “The Path Forward: A State Program that Guides At-Risk Patients to Care,” presented by Cindy Munn, CEO of the Baton Rouge-based Louisiana Health Care Quality Forum, and Ann Kay Cefalu Logarbo, M.D., CMO, UnitedHealthcare Community Plan of Louisiana (based in Metairie, a New Orleans suburb), offered attendees a sense of what it takes to achieve success in efforts to reduce unnecessary emergency department (ED) utilization and improve clinical outcomes, in a Medicaid population.

As Munn—whose organization is a statewide not-for-profit organization that facilitates both quality improvement in hospital- and physician-based organizations across Louisiana, as well as facilitates health information exchange (HIE) and electronic health record (EHR) adoption—noted, what started as a pilot study has now been expanded to all the Medicaid managed care organizations in the state. “The focus of this initiative is around patient-centered care, and moving patients to primary care instead of the ED. We’re also looking at getting data in real time to the health plans and to the providers,” she told the symposium audience, “so that care management activity can occur in a timelier manner.”

The origin of Louisiana’s statewide initiative to reduce unnecessary ED use goes back a few years, Munn said. “What’s the problem? Louisiana is not unique. Non-emergent use of hospital EDs is a critical, complex and costly issue facing Louisiana, and the country. These patients are not getting the care they need, or being care-managed as they should.” She noted that in 2014, Louisiana was the fourth-highest state in the nation in terms of ED utilization, and that in 2013, the state was the third-highest in terms of per capita utilization, with $176 million in excess costs estimated to have come from unnecessary and avoidable ED visits. Analyzing available data, Munn and her colleagues at the Louisiana Health Care Quality Forum found, in fact, that 56 percent of patients could have been better treated in primary care than in the ED setting. In addition, the Louisiana Health Care Quality Forum found that 30 percent of patient visits to EDs in 2015 were followed by at least one more ED visit.

What’s more, Munn told the symposium audience, analysis determined that the most common causes for ED visits have until recently been the following: urinary tract infections; prenatal and post-partum care; abdominal pain; and headaches—with the further finding that pain medication Hydrocodone is both the most commonly prescribed medication in Louisiana EDs—a worrisome finding, given the explosion in opiate abuse being documented in Louisiana and nationwide. Indeed, a significant number of individuals have been identified as “drug-seekers”—people who come into different EDs seeking duplicative prescriptions for opiates.


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more...

“We had nearly a $1 billion budget deficit a couple of years ago,” Munn told the audience, speaking of the Louisiana state government’s fiscal crisis. “We have about a $350 million budget deficit now. And so the legislature is really focusing on where the costs are,” she explained. “And they’re turning out to be with the Medicaid population.” As a result, a Senate resolution passed a Senate resolution in 2014 charged directed Louisiana Department of Health with creating a special committee to address use of EDs for primary are.” The committee ended up recommending the following: the establishment of the Louisiana ED Information Exchange (LaEDIE); the development of a communication plan to educate patients; the development and issuance of prescribing recommendations; and the promote of the use of the state’s drug monitoring program.

Since its creation, LaEDIE has gone live, and now, every day by 9 AM, LaEDIE sends every Medicaid managed care organization in the state a report identifying which health plan members went to the ED in the previous 24 hours, with participating health plans following up to make sure that patients, especially those identified as high-risk patients, be seen within a week by their primary care physicians, with the priority being a focus on the highest-risk patients.

Already, Munn noted, “Of Louisiana’s 110 ED-equipped hospitals, 72 percent are participating. 83 percent of participating hospitals are contributing data. All five Medicaid Managed Care Organizations (MCOs) are participating. And there are have been benefits to all healthcare stakeholder groups. “For consumers,” she said, “the benefit is improved health outcomes. For providers, there is the combination of increased efficiency and reduced cost. For payers, it is “improved quality ratings and reduced cost.” And for employers, it is “improved employee health, reduced cost and increased productivity.” The program is now expanding beyond Medicaid health plans to include commercial payers and to self-insured employers, she noted.

Dr. Logarbo, who shared with the audience that she spent over 26 years in private practice as a pediatrician, said she was motivated to join UnitedHealthcare as medical director nearly two years ago, in order to help create change on a broad scale. With regard to the LaEDIE program, she testified, “Before LaEDIE, there was no actionable data for anyone to do anything with that patient”—the patient who was over-utilizing EDs, because of the fragmentation built into the fee-for-service-based healthcare system. Now, she reported, “We take this data from LaEDIE, and feed it into our ACO organizations. We have a unique registry,” she added. “We have about 11 percent of our population in value-based ACOs. This data from LaEDIE is fed into us daily and then fed into the ACOs, where we have nurse case managers working with the plan members identified as needing intervention. We educate the case managers on how to use the data coming in.”

The program has helped UnitedHealthcare leaders advance one of their main strategic goals: to improve patient outcomes and reduce costs through bringing more plan-participating physicians into value-based care contracts. In addition to working with Medicaid managed care members who are attributed members in an ACO—just 11 percent of their Medicaid population—Logarbo noted that “super-utilizers—the 1.5 percent of the population spending the majority of Medicaid dollars, are automatically now enrolled in the Whole Person Care Model”—UnitedHealthcare of Louisiana’s intensive care management program. “That’s the program managing the sickest of the sick, the highest utilizers,” she explained. Those members have nurse case managers assigned to them who receive electronic notifications every morning about their condition and situation, with members of that team managing that population. In addition, she noted, “On February 1, we opened a new ED care follow-up plan. We pull up every member who’s been in the ED twice in 30 days, or who has a diagnosis of diabetes, COPD, CHF, end-stage renal failure, or asthma, and we’ve added pregnancy to that list”—and those Medicaid health plan members are also actively care-managed.

All of this is further tied into UnitedHealthcare of Louisiana’s intensive efforts to bring as many physicians into shared savings arrangements through its ACOs. In that regard, she noted, “We gave out $2.4 million to our practices in ACO shared savings last year. That’s huge in the context of Louisiana. One practice received $300,000 for addressing gaps in care.”

In all this, Logarbo said, “One of the key lessons learned is that, if you’re going to move to a system of paying for value, you’ve got to look at whole populations. And in order to do that, we’re going to have to leverage IT. We’re going to have to expand to all payer groups. We’re going to have to encourage the participation of all ED-equipped hospitals; and you’ve got to persuade the physicians. We’re able to pay for quality incentives by using this data. By feeding the data to doctors,” she said, “we can leverage a major opportunity for shared savings and quality incentive payments. Last year,” she noted, “249 practices earned a bonus for quality/shared savings. What’s more, 63 percent of UHC Community Plan [Medicaid] members access care from value-based physician practices.” In the end, she noted firmly, “the success of a medical practice is no longer merely based on volume, but on quality.”

The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
| Reprints
The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



More From Healthcare Informatics


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Thursday, December 13, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more substantial role in improving outcomes and reducing cost of cancer care.

In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

Related Insights For: Population Health


At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
| Reprints
The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


Can Informatics Drive Clinical Quality Improvements Alongside Operational Improvements in Cancer Care?

Due to the complexity of the disease biology, rapidly increasing treatment options, patient mobility, multi-disciplinary care teams, and high costs of treatment - informatics canplay a more...

Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



See more on Population Health

betebet sohbet hattı betebet bahis siteleringsbahis