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dialogue
28
NOV / DEC 2013
I
Healthcare Journal of NEW ORLEANS
are you really improving health? It’s about
reallymaking a difference in health for Loui-
siana. Are people having fewer episodes of
asthma, are they keeping their blood pres-
sure under control? Those kinds of things.
Editor:
How’sMagellan going?
Kathy Kliebert:
Again it’s a similar type of
thing. Our first year was about making sure
people currently getting services continued
to get them. There is a lot of change. Par-
ticularly with Magellan, what I mentioned
before about providers that weren’t used to
a managed care system, it was even more
poignant with Magellan. We had provid-
ers who weren’t used to having to do any-
thing other than get contracts billed. They
weren’t used to any type of fee-for-service.
They basically got paid by contract or a coun-
ter rate for that service per day. They didn’t
know at all how to be a Medicaid provider
let alone be a managed care provider. That’s
been our biggest struggle. Some of these
are our own providers—they’ve operated
through our DHH regions, our local districts
least for another year as we determine what
we really need, what the providers really
need, and what the health plans need to do.
Editor:
Has that network improved as a result
of all of this?
Kathy Kliebert:
We are certainly being able to
fill some of the gap areas that we had previ-
ously, but there are still pockets, especially
in rural areas, where we still have some diffi-
culties getting providers. If we had a gap area
previously, you would get a phone call from
somebody saying, “I can’t find a provider in
this area.” Then I would have staff that are
dedicated to do that trying to see if they could
find them a provider in the area. Now, and
these are things we measure, things we are
looking at with the health plans, they’ve got
to show adequate provider coverage.
For instance, one gap area is hematology.
We can tell those health plans you’ve got to
go out and recruit and they’ve got people
on the ground going to doctors and talk-
ing with them. In traditional Medicaid I had
someone here at the office making a phone
call, but certainly not trying to recruit a pro-
vider. These health plans want to have that
adequate network because we are requiring
them to, and they are working hard to allevi-
ate the gap area.
In some areas we’ve seen some major
improvements, but it’s an area that as we
move forward, our goal for the next year or
two is all those things we said we wanted to
happen because of Bayou Health, like mak-
ing sure we had adequate provider network
coverage and specialists in rural areas. One
of the things that we are using more is tele-
medicine in those rural areas, which helps
tremendously especially in those gap areas
like psychology and psychiatry. So they are
doing the things that we wanted them to do.
Our role is going to be holding them
accountable to those things we said we
wanted to happen. The first year was all
about getting people to make a choice on
plans, getting people in plans, making sure
people currently getting services would con-
tinue getting them. Now it’s going to be about
and authorities, and were typically paid by
contract or a counter rate and they didn’t
have the accountability that amanaged care
system requires. So they had to get used to
billing systems, new computer systems, to
be able to bill and be able to assess people,
and it has been a challenge for many of those.
But again the challenge has been with
the providers, not with the people getting
services. We have a much better system
of accessibility, people feel like they have
options, where they didn’t feel like they had
options before. We’ve significantly reduced
inpatient psychiatric hospital stays. I’m
sure you’ve heard about the issue of mental
health beds, especially in the New Orleans
area, and we’ve significantly increased the
number of mental health beds by doing two
things. One, by reducing the length of stay,
you havemore availability of beds. The other
thing we were able to do, throughMagellan,
is we can have what we call “in lieu of ser-
vices.”Previously aMedicaid recipient, if they
were a child that had Medicaid, but wanted
to go to a freestanding psychiatric facility,
Medicaid doesn’t pay for freestanding psy-
chiatric facilities, they pay for acute stays as
part of the hospital. Magellan can determine
if a person needs that level of care, if they
truly need a psychiatric stay, and there’s a
bed available in a freestanding psychiatric
hospital, they can use that bed and pay for it
withMedicaid dollars. It’s flexibility we never
had as Medicaid. With Medicaid you would
not have been able to pay that. It’s just one
example of the types of flexibility you can
have when you have a managed care entity.
It’s just like Bayou Health, they can offer gift
cards, incentives that could not be done in a
traditional Medicaid system.
There are glitches, I won’t say it’s running
perfectly but we are moving very strongly
and it’s a great foundation for mental health.
We’ve got dollars invested. We were able to
increase our dollars by leveraging state dol-
lars that were pure state-funded services
into Medicaid services and have a lot more
money now in the system. By doing that it
lays a really good foundation. There’s still
work to do in terms of getting the community