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Healthcare Journal of NEW ORLEANS
I
NOV / DEC 2013
27
happening—definitely on an individual basis.
So I am optimistically cautious and really
pleased with some of the outcomes and
the cost outcomes as well. The emergency
roomusage is one thing, but we are also see-
ing reduced length of stays and those all cut
costs.We are seeing all the savings we antici-
pated. We built in $135 million the first year
and those occurred—we didn’t have any over-
runs there and those are ongoing savings.
We are also seeing reductions in pre-cost
per person and post-cost per person from
before wemoved tomanaged care andwhere
we are now.
Editor:
Tell me about the significant reduc-
tions inNICUdays inLouisiana. Howwas that
accomplished?
Kathy Kliebert:
We have a partnership between
the Hospital Association, who went out and
worked with us, our own birth outcomes ini-
tiatives, Bayou Health birth outcomes initia-
tives. With all of those combined we have
been able to reduce our NICU days by 20,000
days in one year. A thousand babies went
home earlier because of the birth outcomes
initiatives, primarily due to the 39-week ini-
tiative. It’s basically where a mother is not
induced nor has an elective birth prior to 39
weeks. It was a policy change. It wasn’t done
with mandates or regulations. We literally
went out to hospitals, and the LHA worked
with us, to get hospitals to agree that they
would not induce or have elective deliveries
before 39 weeks. It was one simple change
and it has made a significant difference
along with other things that are done with
the Bayou Health plans. Some of the Bayou
Health plans have staff that go to the NICU
units and work with them on figuring out if
we can prevent some, and also as babies are
in NICU, are there things we can do tomove
them home to their families faster? It’s one
of our big, significant outcomes in terms of
Bayou Health.
Editor:
What about from the provider perspec-
tive?What are you hearing?
Kathy Kliebert:
Well you know providers. In
any of the reforms wemake, it’s been trying to
maintain that provider network andmaking
sure that we’re providing them with at least
a level of reimbursement, a level of comfort
in terms of paperwork and the administra-
tive burden that they have.We had towork on
things like administrative burden and other
things and we continue to work with them
on those things. But in general we don’t have
any provider groups coming and asking to
meet with me and saying this isn’t working.
Any time you go through a change like
that it’s hard, especially for providers that
were maybe total Medicaid providers and
had not done managed care in the private
system. Most people who had done man-
aged care through private insurance adapted
more easily. Medicaid fee-for-service was
pretty good—I submit my bill I get paid, and
pretty quickly. Now they are paying quickly,
that’s not an issue, but any time youmanage
care and really look at utilization and look
at the types of services people get as well as
doing interventions before people go to an
emergency room, interventions in discharge
planning, you are going to have that resis-
tance. I wouldn’t really call it resistance, but
it’s change and whenever you have change
you have people who don’t want to change.
I think for the legitimate issues—there were
some administrative burdens in particular—
we worked with the plans to work with pro-
viders on dealing with some of those prior
authorization forms and other things, and we
continue to have an administrative burden
reduction group that’s working out some of
those issues. That’s going to be ongoing at