Friday, April 26, 2019

Making 2019 the Year of Public Health for Louisiana

By DR. ALEXANDER BILLIOUX | Assistant Secretary, LDH Office of Public Health

At the beginning of every year, many of us make resolutions for the year to come, and most of those relate to goals to improve our health. With Louisiana Department of Health Secretary Dr. Rebekah Gee declaring 2019 the “year of public health,” the Office of Public Health is no different. We are setting some big goals to improve Louisiana’s health, and big goals are needed because the state faces big health challenges.

The United Health Foundation’s America’s Health Rankings often ranks Louisiana among the least healthy states in the country. However, a closer inspection of this year’s results reveals a more complicated picture of the state’s health. Medicaid expansion continues to drive down the state’s rate of uninsured individuals, and perhaps as a result, the number of Louisianans with dedicated healthcare providers has increased. Similarly, access to care likely had some impact on improvements we achieved in the rates of cancer deaths, childhood immunizations and suicides last year.

So then why does Louisiana continue to be ranked low with all these improvements? The answer reminds us that achieving and maintaining good health requires more than healthcare. Indeed, though we performed well on many direct measures of healthcare and public health services, we continue to have some of the nation’s worst rates of infant mortality; infectious diseases like HIV, hepatitis C and syphilis; and chronic illnesses like obesity, heart disease and diabetes. These illnesses drive the high levels of preventable hospitalizations and early deaths that continue to challenge us.

Understanding what is driving those conditions is critical to shaping our response, and the America’s Health Rankings report sheds some light there as well. We know that social, behavioral and environmental factors have a three to six times greater impact on health than access to healthcare. So Louisiana’s high rates of disconnected youth, violent crime and un/under-employment, along with low rates of high school graduation and median income, not only mean life is harder for many in our state, but that these factors are also robbing us of health and life.

The Year of Public Health

Rising to these meet these health challenges and truly “moving the needle” on the state’s health will require more than simply doubling down. Improving the health of all Louisianans requires nothing less than a shift to a culture of health statewide. The Office of Public Health can and will lead that shift, but we cannot do this alone.

We need to expand our reach into communities and create new allies among businesses, schools and community organizations and leaders. We need to communicate the value of focusing on health, both to improve our neighbors’ lives, as well as to stop health care costs from consuming all other resources across the state. If you care about building new schools and paying teachers to train our future workforce, or building new roads to get your products to stores and consumers, or being able to invest more in helping our communities prosper, you need to care about improving health.
To lead this culture shift, the Office of Public Health plans to innovate, partner and lead the state to a future of better health.

We are innovating by applying new strategies to tackle some of our biggest health challenges, like launching our house call-based syphilis treatment program for pregnant women and their partners. Or by establishing the nation’s first statewide hepatitis C elimination program by combining a game-changing drug purchasing arrangement, giving the state unrestricted access to treatment with a public health-led effort to screen, link into care and cure those living with hepatitis C in the Medicaid and corrections populations over the next five years.

We are partnering with health systems and providers across the state by sharing local health data and helping set targets for care improvement; as in our Perinatal Quality Collaborative focused on reducing Louisiana’s high levels of maternal mortality in partnership with 31 birthing facilities across the state. Or by participating in the Secretary’s Taking Aim at Cancer in Louisiana initiative, bringing together health systems, researchers, insurers and advocates to reduce the state’s high rates of breast and colon cancer, especially among people of color.

And, we will lead by engaging businesses, schools and local governments across the state to establish policies and programs addressing the social determinants of health, such as by helping establish more smoke-free zones and by launching a new health-related social needs navigation pilot program in St. Landry Parish.

I am grateful to be able to join you all in this incredibly important work. Together, we will take on these challenges and improve the health of our state. As President John F. Kennedy observed: “… that challenge is one that we are willing to accept, one we are unwilling to postpone and one which we intend to win.”

Thursday, April 18, 2019

Medicaid audits include important findings but should be kept in context

By JEANIE DONOVAN | Policy Director, Louisiana Department of Health

Medicaid is arguably the most impactful public program in the state, and that’s why the Louisiana Department of Health (LDH) has a steadfast commitment to maintaining the program’s integrity. Medicaid promotes the health and wellbeing of 1.7 million low-income Louisianans. While recent audit findings released by the Louisiana Legislative Auditor are used by some as evidence that improper enrollment and fraud are pervasive in Louisiana’s Medicaid program, that is far from reality.

Improper enrollment and recipient fraud in Medicaid are the exceptions rather than the rule. Also, it is important to distinguish that recent legislative audits primarily identified cases of human error or neglect rather than actual fraud, which is defined by the federal government as the intentional provision of false information to get Medicaid. One audit by the Legislative Auditor estimated about 3% of all Medicaid expansion enrollees had wages above the eligibility limit after enrolling in the program and did not self-report their excess wages to the Department, as required by the state’s eligibility policy. Another audit identified five Medicaid expansion cases in which a caseworker’s error or failure to follow established protocol resulted in individuals who earned above the income limit being improperly enrolled in Medicaid.

It is important to remember that Medicaid expansion enrollees who had incomes above the eligibility limit did not receive any direct payments. Instead, the funding went to health insurers and healthcare providers responsible for delivering services to those individuals. What’s more, between federal Medicaid funding and premium taxes paid by health insurers to fund Medicaid expansion in Louisiana, no state general fund dollars are used for Medicaid expansion.

Still, any funding spent on an ineligible person is funding that could have been spent on another important purpose.  That’s why LDH, over the past two years, has greatly enhanced its investment in program integrity functions. Through our new eligibility and enrollment system, LDH is able to reduce caseworker error and more rigorously and regularly verify Medicaid recipients’ eligibility. Our new eligibility system has enhanced functionality that currently checks wage data and will soon check tax data to ensure that all recipients are earning below the eligibility limit, as recommended by the Legislative Auditor.

The department’s new Medicaid Recipient Fraud Investigations Unit is investigating cases and collaborating with the Louisiana Attorney General’s office to prosecute cases of Medicaid fraud. Recently, the Trump administration’s Centers for Medicare and Medicaid Services shared several of LDH’s Medicaid program integrity efforts for others states to consider.

LDH staff take the audit findings very seriously and have worked diligently to incorporate the recommendations of the Legislative Auditor into the Medicaid program. It is important, however, that the magnitude of the audit findings not be overstated or misrepresented. The vast majority of Medicaid recipients are eligible for the program and use their Medicaid health coverage to access needed medical care. The program is improving and saving lives in every town, city and parish across the state of Louisiana — a fact that is often overlooked or diminished in the ongoing conversations about program integrity.

Friday, April 12, 2019

Is your baby up to date on vaccinations?

By STACY HALL, RN, MSN | Immunization Program Director, LDH Office of Public Health

Vaccines are safe, effective and prevent disease, yet only 72% of infants in Louisiana are up to date with immunizations. Vaccination protects the child and entire communities by preventing and reducing the spread of serious infectious diseases. Please join me in celebrating National Infant Immunization Week to highlight the importance of protecting infants from vaccine-preventable diseases and promoting healthy communities in Louisiana and throughout the United States. This year, National Infant Immunization Week will be April 27 to May 4.

Because of the success of vaccines in preventing disease in the U.S., parents may not have heard of some of today’s vaccines — including the inactivated polio vaccine and DTaP vaccine — or the serious diseases they prevent. These diseases can be especially severe for infants and young children. Protection begins before a baby is even born. Learn more about the importance of maternal vaccination at and follow the recommended immunization schedule to protect infants before they encounter potentially life-threatening diseases.

Vaccine-preventable diseases such as measles and whooping cough still circulate in the United States and around the world, so continued vaccination is necessary to protect everyone from potential outbreaks. The Centers for Disease Control and Prevention declared measles eliminated from the United States in 2000, but the disease has made a comeback because of mistrust regarding the safety of vaccination. The second-greatest measles outbreak since elimination is ongoing, with over 450 cases in 19 states since January 1, 2019. Information on this measles outbreak, vaccination recommendations and resources are available at

2019 marks the 25th anniversary of the Vaccines For Children (VFC) program. VFC is a federally-funded program that provides vaccines at no cost to children who might not be able to afford the shot. The VCF program helps children get their vaccines according to the recommended immunization schedule. It has helped increase childhood immunization coverage levels, making a significant contribution toward making coverage more equal among young children.

Healthcare professionals remain parents’ most trusted source of information about vaccines for their children. They play a critical role in supporting parents in understanding and choosing vaccinations, and will help keep children up to date on vaccinations and work with parents to get their child caught up if they fall behind. The Louisiana Department of Health’s Healthy Babies Don’t Wait, Vaccinate webpage can help you find a VFC provider in Louisiana.

National Infant Immunization Week is a reminder of the importance of keeping up to date with vaccinations. Louisiana can do better than not protecting more than a quarter of our babies with timely immunizations. See how the infants in your parish are doing here.

Friday, April 5, 2019

STD conversations don’t have to stay in the dark

Number one for case rates of newborns born with syphilis.

Number two for chlamydia case rates.

Number three for primary and secondary syphilis case rates.

Number three for gonorrhea case rates.

These statistics belong to Louisiana, and they’re sobering. The rates of sexually transmitted diseases — syphilis, chlamydia, gonorrhea and more — in our state make it vital that we have conversations about STDs: what they are, how they are spread, how they can be treated and how they can be prevented.

April is Louisiana STD Awareness Month. Like many other states around the U.S., Louisiana is participating in efforts to draw attention to STD awareness. And, because sexually transmitted diseases are often talked about in hushed whispers or not at all, that makes this year’s theme all the more important: “Start the Conversation — About STDs.” The slogan for this year’s campaign is, “It doesn’t matter how, it just matters that you do. Start the conversation!”

Three simple rules

The federal Centers for Disease Control’s Talk. Test. Treat. campaign encourages these three simple actions to protect yourself and others from STDs.

  • Talk openly and honestly to your partner(s) and your healthcare provider about sexual health and STDs.
  • Talk with your partner(s) BEFORE having sex. Not sure how? We have tips to help you start the conversation. Make sure your discussion covers several important ways to make sex safer:
    • Talk about when you were last tested and suggest getting tested together.
    • If you have an STD (like herpes or HIV), tell your partner.
    • Agree to only have sex with each other.
    • Use latex condoms from start to finish every time you have sex.
  • Talk with your healthcare provider about your sex life, and ask what STD tests you should be getting and how often.
    • Not all medical checkups include STD testing, so don’t assume that you’ve been tested unless you discuss it with your provider.
    • Ask your doctor whether certain vaccines, like the hepatitis B vaccine or the HPV vaccine, are right for you.
  • Get tested. It’s the only way to know for sure if you have an STD.
  • Many STDs don’t cause any symptoms, so you could have one and not know. If you’re having sex, getting tested is one of the most important things you can do to protect your health.
  • Find out which STD tests CDC recommends for you. Even if you’re pregnant, you can still get an STD. If you’re having sex, you’re still at risk.
  • If you’re not comfortable talking with your regular healthcare provider about STDs, find a clinic near you that provides confidential testing that’s free or low cost. (The Louisiana Department of Health’s STD/HIV Program administers statewide and regional programs. Learn more here.)
  • If you test positive for an STD, work with your doctor to get the correct treatment.
  • Some STDs can be cured with the right medicine from your doctor, and all STDs are treatable. Make sure your treatment works by doing these things:
    • Take all of the medication your doctor prescribes, even if you start feeling better or your symptoms go away.
    • Don’t share your medicine with anyone.
  • Avoid having sex again until you and your sex partner(s) have all completed treatment.
  • Your doctor can talk with you about which medications are right for you.
Don’t be afraid to have the conversation. Talk about it, get tested and if needed, get treated. Take care of yourself and those around you.