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46
NOV / DEC 2013
I
Healthcare Journal of NEW ORLEANS
outcomes for patients with chronic diseases such
as diabetes, coronary artery disease, hyperten-
sion, and chronic kidney disease.
Blue Cross developed QBPC to better support
physicians in the network and transform the
relationship among primary care physicians,
the insurer, and patients. The program takes an
episode-driven, physician delivery care model to
a more coordinated, team care delivery model.
QBPC gives providers the tools and resources they
need to focus on improving care quality for their
total patient population, not just those who are
actively seeking treatment.
Blue Cross and doctors will share data to better
understand the health challenges their mutual
patients face. AQuality Blue “navigator”will work
with a “practice coordinator” at each enrolled
doctor’s office to prepare for scheduled office
visits. Blue Cross nurses will work with patients
between doctor visits to help them stick to their
care plans andmanage their chronic conditions.
For more on Quality Blue Primary Care, visit
www.bcbsla.com/qbpc.
State Gains Extension
of GNOCHC
Department of Health and Hospitals Secretary
Kathy Kliebert, Louisiana Sen. David Heitmeier,
andNewOrleans officials announced the planned
extension of a program focused on advancing
and sustaining access to healthcare services in
the New Orleans area. The program, called the
Greater New Orleans Community Health Con-
nection (GNOCHC), is a Medicaid demonstration
waiver that provides primary care and behav-
ioral health care services to more than 60,000
individuals in Orleans, Jefferson, St. Bernard and
Plaquemines parishes.
Thewaiver was expected to expireDec. 31, 2013,
but revisions by DHH submitted to the Centers
for Medicare and Medicaid Services would allow
the waiver to extend through 2014, giving local
officials additional time to find funding needed to
maintain the program for future years.
A temporary, no-cost extension filed by DHH
seeks to restructure the GNOCHC waiver in order
to ensure that itmay continue to operate through
the end of 2014 using only the remaining funds
available--$6.1 million in previously authorized
Community Development Block Grant funds. The
revisions to the waiver include the following:
• Limiting enrollment to individuals with
incomes below100 percent of the federal poverty
level, whichwill align the eligibility criteria so that
individuals making more than 100 percent of the
federal poverty level would access health cover-
age through the federal exchange;
• Reducing the primary encounter rate by less
than 13 percent;
• Eliminating infrastructure payments to pro-
viders; and
• Decreasing supplemental payments sched-
uled to bemade for the current programyear and
eliminating them for the next program year.
The Centers for Medicare andMedicaid Services
(CMS) will still need to review and approve the
temporary waiver extension. GNOCHC currently
has more than 60,000 enrollees with access to
more than 40 clinic locations.
For more information go to nola.gov/gnochc.
Louisiana Leads in Medicaid
Fraud Recovery Rates
Louisiana recovered more than $124 million
fraudulent payments in the Medicaid program in
criminal and civil penalties in the Fiscal Year 2012
according to figures fromthe Centers for Medicare
and Medicaid Services. That is the highest rate of
recovery in any state in the nation at nearly 2 per-
cent of all Medicaid dollars spent in Louisiana. On
average, states recover less than 0.6 percent of
their respective Medicaid budgets.
Medicaid fraud cases are typically identified
through investigations conducted by the DHH
Medicaid Program Integrity division. The investi-
gators work to distinguish billing errors from true
fraud cases. In the event of a billing error, pro-
gram staff or Medicaid billing contractor Molina
conducts education or training of correct billing
practices.
In the last fiscal year, the Program Integrity divi-
sion recoupedmore than $4.5million administra-
tively. The Division also made 186 referrals to the
Attorney General’sMedicaid FraudControl Unit for
further investigation.
Members of the public and the healthcare
industry are critical players in identifying and
fighting fraud. Individuals who suspect or have
knowledge of fraudulent behavior or billing are
encouraged to report it. More information on how
to fight fraud in Louisiana may be found at www.
dhh.la.gov/fightfraud.
LNHA Launches Long-
Term Care Ad Campaign
The Louisiana Nursing Home Association has
launched a television advertising campaign enti-
tled “Care Conversations.” The campaignwill edu-
cate Louisianans on how to begin a conversation
with loved ones discussing their long-term care
needs. This 30-second commercial spot will run
on various cable channels throughout the state.
Joe Donchess, Executive Director of LNHA, com-
mented, “We are excited to raise awareness of the
long-term care information and resources LNHA
provides to the public. Seventy percent of us will
need long-term care after age 65, yet few openly
discuss care needs and wishes. LNHA is working
to change this conversation trend.”
One such tool is CareConversations.org. This
website provides information and resources to
get people talking with loved ones, health care
providers and industry experts. Care Conversa-
tions focuses on people and the honest discus-
sions needed to plan and prepare for the future.
For more information visit www.lnha.org.
Couvillon to Administer State
Group Health Benefits
Blue Cross and Blue
Shield of Louisiana
has named David
Couvillon director
of the company’s
internal Office of
Group Benefits (OGB),
a department in Blue Cross’
Benefits Administration Division. Couvillon will
oversee the administrationof benefits for the state
group’s PPO, HMO and consumer-driven health
plan (CDHP) benefit plans. He comes toBlue Cross
fromXerox Services inBatonRouge, where hewas
an operations manager for Louisiana customer