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dialogue
26
NOV / DEC 2013
I
Healthcare Journal of NEW ORLEANS
are, and then you can
find support for them
to meet their goals. In tra-
ditional Medicaid if I had a high
risk case, I didn’t have a case manager to
assign to those individuals to really get to
know what’s important to them, what will
work for them. These health plans do. For
all of their high risk cases they are assigning
individual intense case managers to learn
about the person, provide support, whether
that’s text messaging, calling, giving them
incentives to quit smoking, all of the things
we wanted to see happen in terms of han-
dling some of those people that kept show-
ing back up in emergency rooms, hospitals,
or free clinics because they couldn’t keep
on their medications. All of those things are
because nursing homes and ICF/DDs are
still needed. And will still be needed. So you
don’t want to eliminate that level of service.
Editor:
Switching gears now, howwould you say
BayouHealth is going?
Kathy Kliebert:
Well I certainly have been
pleased. I do quarterly reviews with the
health plans and they give me statistics in
terms of how we are doing with things like
emergency room usage, repeat hospitaliza-
tion—a number of indictors that they look at.
At the same time we are waiting on all of our
statistics on our HEDIS measures and our
qualitymeasures.We won’t have even some
HEDIS-like measures until after November.
You have got towait a full year of implemen-
tation then several months afterwards to be
able to get good quality indicators.
However I can tell you anecdotally from
some of the stories and from some of
the key indicators they do report
on, like reducing non emergent
emergency roomuse, which is
significant. If you can reduce
that you can reduce costs.
Then they’re also setting
up disease management
programs that are working
for individuals. And again
most of it is anecdotal at this
point, so I amanxious to get the
global data that means it’s work-
ing everywhere, but we’re getting some
really great stories where they are coordi-
nating care and being able to provide things
for individuals—incentives for individuals.
There have really been some cases where
they’ve just provided people with adaptive
equipment and enabled them to reduce some
of the extra visits they were having. Simple
things like that, that they can do that tra-
ditional Medicaid couldn’t do. We couldn’t
offer those incentives.
My background is in developmental dis-
abilities and I learned really early on that
the way to change behavior for individuals
is you get to know them, who they are and
what their priorities are, what their values
homes. We have typically relied on institu-
tional settings to provide services, not hav-
ing community-based options available. So
clearly we want to change that and we’ve
worked really hard to change that dynamic in
rebalancing our services. We certainly would
like to be able to do that more. Again it will
be based on where we are at. We’ve made a
lot of progress over the last five years; how-
ever we want tomove further with that.We’re
just going to it in a way that’s deliberate and
making sure that wemaintain services as we
move away from those institutions.
Editor:
It sounds like there is kind of a market
for those community-based services.
Kathy Kliebert:
We do have a lot of commu-
nity-based providers now. Whether that’s
providing personal care services at home,
or for developmental disabilities we have
some comprehensive waiver services. There
are day programs that provide community-
based services. We have providers. What we
don’t have yet is enough to take care of our
waiting list. Not that any state really does.
I think every state has a waiting list of the
elderly looking for those home and commu-
nity-based services. The challenge is deter-
mining who really needs it now. The wait-
ing list often includes people who think they
might need services down the road. So, how
do you try and make sure that the people
who really need the services now are get-
ting them and that they are getting them in
basically the smaller segments of services
versus the whole comprehensive service
like an institutional service because that’s
all we had? That’s what we have typically
done. When somebody needs some level of
support we end up providing institutional
services rather than providing some of those
less intense services, a lower level of services.
But you have got to have them in place.
You are correct in that it’s a good market
for those providers, but at the same time we
don’t have enough ability right now to recon-
struct so that I’ve got funding for all of those
services. It is a reconstruction and we don’t
want to destroy the system that we have,