Baton Rouge: Louisiana's health care history marked a milestone as the Department of Health and Hospitals finished the initial implementation of its new Medicaid delivery model, BAYOU HEALTH.
The majority of Louisiana's 1.2 million Medicaid and LaCHIP recipients will now have their care coordinated through a Health Plan network. Of the nearly 900,000 recipients who are part of BAYOU HEALTH, nearly 40 percent proactively chose a Health Plan for their families.
"For years, we have talked about getting Louisiana off the predictable path to poor health outcomes. This achievement marks one of the most meaningful steps on that journey," said DHH Secretary Bruce D. Greenstein. "BAYOU HEALTH is the first fundamental transformation of Louisiana's Medicaid program since it was created in the late 1960s. More importantly, it was carefully designed to ensure better, more coordinated care for those who depend on us."
"Our Medicaid team has done tremendous work in the past four years to examine similar programs in more than two dozen states. Based on their extensive research and own experiences, we created in BAYOU HEALTH what is not only the right model for Louisiana, but what I believe will become a national model for Medicaid health care delivery."
BAYOU HEALTH is the State's new approach to coordinating care for most Medicaid and LaCHIP recipients. Its focus is on improved access to quality health care and better health outcomes for recipients. Under BAYOU HEALTH, DHH contracted with five Health Plans - Amerigroup RealSolutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and UnitedHealthcare Community Plan -- that are responsible for coordinating health care for recipients and working with them to address issues and empower them to take a more active role in their health.
BAYOU HEALTH Enrollment
BAYOU HEALTH was implemented for eligible Medicaid and LaCHIP recipients around Louisiana in three phases that each encompassed multiple parishes, known as a Geographic Service Area, or GSA. The New Orleans and Northshore-area parishes, GSA A, were the first parts of the state to go live with BAYOU HEALTH on Feb. 1. On April 1, GSA B, which included the Capital Area, Acadiana and South Central Louisiana parishes, implemented BAYOU HEALTH. The final go-live date for GSA C, which included the parishes in Southwest, Central and North Louisiana, was last Friday, June 1.
Statewide, nearly 40 percent of all eligible Medicaid and LaCHIP recipients chose their own Health Plans, either selecting a Plan before their GSA's go-live dates or switching later to a Plan of their choice.
For the 878,035 Louisiana Medicaid and LaCHIP recipients who are part of BAYOU HEALTH, the breakdown of their Health Plan choices as of June 1 is:
- Amerigroup Real Solutions - 143,590
- Community Health Solutions - 185,504
- LaCare - 155,789
- Louisiana Healthcare Connections - 168,736
- UnitedHealthcare Community Plan - 222,010
There were 2,406 Medicaid and LaCHIP recipients whose enrollment in BAYOU HEALTH was voluntary and elected to remain in the fee-for-service program, which is less than 1 percent of all BAYOU HEALTH-eligible enrollees.
In GSA C alone, nearly 33 percent of eligible recipients chose their own Health Plans. Those who did not choose a Plan were assigned to one to begin receiving services through a BAYOU HEALTH Plan on June 1.
Of the 297,882 eligible Medicaid and LaCHIP recipients in GSA C, the breakdown of BAYOU HEALTH Plans they were enrolled with for the June 1 go-live date is:
- Amerigroup Real Solutions - 51,031
- Community Health Solutions - 64,075
- LaCare - 55,170
- Louisiana Healthcare Connections - 61,927
- UnitedHealthcare Community Plan - 64,887
There were 792 recipients in GSA C who chose to stay in the Medicaid fee-for-service program.
"The most rewarding part of implementing BAYOU HEALTH is the positive feedback we've heard from Medicaid and LaCHIP recipients," said Ruth Kennedy, incoming Medicaid Director and BAYOU HEALTH Project Director. "Many of them have indicated they enjoy being part of a network and having care coordination, and we've gotten several stories of how Health Plans have helped members get prescriptions filled, make appointments or find a ride to their doctor's office. We know any change can be intimidating, so we're pleased to see many recipients are adapting well to this new model."
Some examples of positive comments recipients and providers have shared with DHH since BAYOU HEALTH began:
- In the Hammond area, prior to BAYOU HEALTH, there was only one primary care provider who would take new adult patients on Medicaid through the previous CommunityCARE program, and four other providers who would only see adult Medicaid recipients if they had been a patient before becoming eligible for Medicaid. After BAYOU HEALTH, with the Health Plans' work to establish networks, there are 30 primary care providers in Hammond taking new adult Medicaid patients.
- An adult recipient who has diabetes contacted the nurse care management hotline for her Health Plan, saying it had been more than 12 years since she had a working blood glucose monitor. She also needed new eyeglasses and had an updated prescription, but she was unable to afford the glasses. The Plan's care management staff contacted the recipient's primary care provider to get her a new blood glucose monitor, which is covered through the Health Plan. The Plan's care management staff also contacted a local nonprofit organization and arranged for them to assist the recipient with purchasing new eyeglasses so she could see well enough to use her new blood glucose monitor effectively. The member told care management, "This new managed Medicaid program with a nurse [available via phone] is the best thing Louisiana could have ever done."
- An adult Medicaid recipient who has hypertension and diabetes had scheduled a checkup with his primary care physician in January, but didn't have any transportation to get there and skipped the visit. As a result, he didn't get updated prescription refills and went without medication he needed for these conditions for six weeks. This recipient is in GSA A and joined a BAYOU HEALTH Plan on Feb. 1, and he contacted his Plan's care management staff on a Friday evening to advise that he had been without medication and might need emergency treatment for his health issues. The care management staff contacted the member's primary care physician and arranged for an urgent refill prescription to help the recipient avoid winding up in an emergency room. The care management staff then contacted the recipient's pharmacist to call in his prescription, and followed up with the recipient to let him know his medications would be available for pickup Friday night. The recipient told the care management staff he "would never have been able to get medicine refilled in a matter of 45 minutes without the assistance from a care management nurse," and was very appreciative.
- A provider for a LaCHIP recipient was trying to receive a quick approval for inpatient rehabilitation services to treat her patient. The provider indicated she had previously encountered "frustrations and roadblocks" in trying to get similar services, but when she reached the recipient's Health Plan, she received a same-day authorization for the inpatient rehabilitation. The provider told the Plan's staff they were very easy to work with, and said she was "pleasantly surprised" with the fast turnaround on her request.
Eligible Medicaid and LaCHIP recipients had numerous opportunities and methods available to choose a Health Plan for themselves and their families. BAYOU HEALTH outreach staff scheduled "Choose Health" meetings throughout each GSA leading up to that area's go-live date, which gave recipients a chance to meet with representatives of the Plans in person and work with an enrollment specialist to choose a Plan.
DHH used a broad strategy including direct mail, social media, television and radio appearances and phone calls to reach as many recipients as possible and make them aware of the coming changes with BAYOU HEALTH as well as their options for choosing a Health Plan.
Recipients who are unsure about which BAYOU HEALTH Plan they are in can contact the BAYOU HEALTH enrollment hotline at 1-855-BAYOU-4U (1-855-229-6848).
Recipients will receive a confirmation letter from the BAYOU HEALTH Enrollment Center listing which Health Plan they are linked to, and will receive membership cards from their Plans in addition to their DHH-issued Medicaid cards. Members have an opportunity to select a primary care provider from their Health Plan's network. If the member does not choose a primary care provider, the Health Plan will automatically assign one.
Any Medicaid recipient in GSA C who had surgeries or other medical procedures scheduled before June 1 was pre-authorized for these procedures under BAYOU HEALTH.
Recipients in GSA C, and many of those in GSA B, still have a chance to choose a Health Plan if they decide their current Plan is not a good fit. Medicaid and LaCHIP members have 90 days from the time they are enrolled in a Health Plan, either by choice or by auto assignment, to switch to another Plan. After that, a recipient can change Health Plans anytime with a good reason, such as their primary care provider leaving the network or if they move to a different area of the state. Medicaid and LaCHIP recipients will have an annual opportunity to change Health Plans. BAYOU HEALTH recipients who wish to change Health Plans can call 1-855-BAYOU-4U (1-855-229-6848) to speak with an enrollment specialist or change Plans online at www.bayouhealth.com.
"We will continue to work with those who become newly eligible for Medicaid to educate them on the importance of choosing a Health Plan," Greenstein said. "But while we welcome a new era of unprecedented choice, access and assistance for Medicaid recipients, we also want to emphasize the importance of personal accountability. Owning your own health means not only choosing a Plan, but also taking the steps to eat better, get more exercise and live well. BAYOU HEALTH is an important piece of the puzzle, but everyone has a role in improving our state's health."
DHH has worked closely and collaboratively with medical providers throughout the transition to BAYOU HEALTH, and will continue offering resources to provide information and assist providers as needed.
Medical providers can see which BAYOU HEALTH Plan a Medicaid or LaCHIP recipient they treat belongs to through the online Medicaid eligibility verification system, eMEVS. This information tells providers which BAYOU HEALTH Plan to bill for services or obtain authorizations as needed. Providers should consider the Medicaid eligibility database the ultimate source of information for BAYOU HEALTH Plan assignment. A patient may think he or she is in a different Plan or have a letter or membership card from another Plan, but the eMEVS information takes precedence.
Providers can e-mail email@example.com for assistance with any issues or questions that arise. BAYOU HEALTH staff are typically able to address any emailed questions or concerns within one business day. Medicaid staff will continue holding a BAYOU HEALTH call for providers each week day from noon until 1 p.m. Representatives from each of the five BAYOU HEALTH Plans also participate in the call to answer questions and address concerns. The toll-free number to call is 1-888-278-0296, and the Access Code is 729-9088#. It is not necessary to pre-register for the call, and any interested provider can participate.
DHH's BAYOU HEALTH website, www.MakingMedicaidBetter.com, contains abundant information about the program, including specific information for providers. This site is updated daily to provide the latest details on BAYOU HEALTH implementation. Medicaid staff members who are implementing BAYOU HEALTH have developed a series of numbered Informational Bulletins for providers and stakeholders, which answer frequently asked questions about the initiative and/or consolidate information from each of the five BAYOU HEALTH Plans into a single document. These are available on the website, and BAYOU HEALTH emails an alert whenever staff add a new Informational Bulletin or update an existing one. Providers who wish to be on the list to receive these email alerts can sign up through www.MakingMedicaidBetter.com, clicking the "Subscribe to Newsletter" link, or emailing firstname.lastname@example.org and requesting to be added to the BAYOU HEALTH email list.