The ‘State of the State’ of healthcare in Louisiana

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

Recently, I had the opportunity to speak before the Rotary Club of Baton Rouge on the state of healthcare in Louisiana, looking back on our accomplishments while keeping our eyes on the future. I’d like to share some of those achievements here with you.

The success of Medicaid expansion in Louisiana is something to be proud of. It is truly making a difference in the lives of some of our most vulnerable residents. We are proud of Governor John Bel Edwards and the progress this administration has made when it comes to Medicaid expansion and improving access to healthcare.

Medicaid expansion has been responsible for:

• The state’s uninsured rate dropping by half, down to only 8%
• Tens of thousands of people receiving access to cancer screenings
• Over 100,000 people accessing needed mental health and addiction treatment
• The largest growth in federally qualified health centers (FQHCs, or community health centers) in the nation, and unlike many in our region, our rural hospitals remain open for business
• $282 million in savings for the state budget, and by extension Louisiana taxpayers
• 14,000 new jobs and $889 million in personal earnings
• Fewer people putting off going to the doctor or not taking medications as prescribed because they can’t afford the cost

The reality is Medicaid expansion in Louisiana has been a great success. Bringing federal tax dollars home to Louisiana has allowed the state to solve a budget deficit, keep the TOPS scholarship program in place, and support roads and other infrastructure.

In addition to expansion, and under the leadership of Governor Edwards and outgoing Secretary Dr. Rebekah Gee, the Department of Health has seen many other improvements to our healthcare landscape.

Because of the work of the Department of Health, FQHCs and other providers and community partners, in July we announced that fewer people have been diagnosed with an HIV infection in the past year than in any of the previous 10 years. In 2018, there were under a thousand — 989 people newly diagnosed with HIV — for the first time in a decade.

The CDC’s national STD rankings show Louisiana’s prevention efforts are paying off. Louisiana’s case rates of primary and secondary syphilis, congenital syphilis and gonorrhea improved from 2017 to 2018:

• Primary and secondary syphilis: #7, down from #3
• Congenital syphilis: #3, down from #1
• Gonorrhea: #5, down from #3

Improvements such as these take time, and show that increased screening, education and prevention efforts are making a difference.

We are leading the nation on a new model to expand access to hepatitis C treatment. Our agreement with Asegua Therapeutics provides unlimited access of Asegua’s authorized generic of Epclusa to Louisiana Medicaid recipients and Louisiana Department of Corrections inmates while capping the state’s annual expenditures. We want this life-saving treatment to reach everyone in the state over the next five years.

Since medications became available on July 15, more than 2,400 people have been treated so far. Our ambitious public health strategy to screen and treat as many people as possible prioritizes educating the public, encourages screenings to determine one's status, links individuals living with hepatitis C into care and extends the cure to as many Louisianans as possible. We’ve also launched a partnership with Wal-Mart to offer free screening in 10 stores across the state.

Through this work, we are aiming to be the first state in the nation to eliminate the deadliest infectious disease in the country.

Medicaid re-entry program

Our work for hepatitis C represents our strong partnership with the Department of Corrections, which is rare nationally. Another great partnership are proud of is our Medicaid re-entry program for prisoners, which ensures people who have served their time will have Medicaid when they are released. This means they will have access to mental health services, medications and primary care. We have had more than 10,000 applications for this program.

KickStart pilot

In Monroe, we are running a pilot program called KickStart that connects Medicaid recipients to job training, helping them reach financial independence through work. We are hearing early success stories: A son who was already enrolled in a training program began studying alongside his mom when KickStart became available. The mom who always put her child's needs before her own has now completed training as a forklift driver.

Sixteen Louisiana Department of Health employees have earned their Lean Six Sigma Green Belts.

Continuous quality improvement

Beyond these programs, the Department of Health is also very focused on always striving to be more efficient and do more with the state and federal dollars we are entrusted with. Our goal is to ensure we are effective and eliminating waste. So, under the Secretary’s leadership, we started training our employees on a program called Lean Six Sigma, which empowers employees to fix problems. Nearly 50 leaders across the agency have completed the initial yellow belt training and another 16 have trained on the next-level green belt segment that allows them to oversee their own projects.

These employees have become the bridge between different offices who have identified problems, reduced excess steps in our processes and provided better services. We are already seeing the benefits of their initial projects, and more importantly a culture of continuous quality improvement is taking hold and spreading across the Department.

Maternal mortality

This focus on outcomes and quality improvement also extends to our approach to improving health. One example is the Louisiana Perinatal Quality Collaborative, a collaborative that is focused on reducing the number of women who die or are seriously injured related to childbirth. No woman should die giving life.

Through training programs, staff support and the sharing of best practices, we've set an ambitious goal to reduce maternal morbidity by 20% by this Mother's Day. We have already seen some early wins: Since 2016, we’ve seen a 32% drop in the severe health consequences of bleeding in moms who are giving birth.

Eliminating waiting lists

We have also been successful in eliminating a waiting list for services for people with developmental disabilities — there were over 10,000 people on that waiting list, which has existed for 25 years. That list has been eliminated and now the needs of the people with developmental disabilities are being met.

We want to replicate this success for our older adult community and we are working to drastically reduce the waiting list for home and community-based health services for older adults.

Nursing home quality improvement

Many of our state’s older adults are also benefiting from improved quality in our nursing homes. A training program to reduce the incidence of pressure ulcers in Louisiana nursing facilities has resulted in some dramatic improvements. The state has moved from 50th in the United States in 2016 to 45th in the first quarter of 2018. We have more work to do but we are making progress.

Dr. Alexander Billioux speaks to the Rotary Club of Baton Rouge.

Call to action

We at the Department of Health are optimistic about the future, but we know that we did not get here without hard work, and this improvement will not continue without even more effort and focus on our ultimate goal: improving the health of ALL Louisianans everywhere.

We know that achieving this will take more than increasing access to healthcare — though that is critical — it will mean that we must also work to improve the efficiency and impact of the healthcare system our citizens are accessing. Ultimately, it means working to improve health upstream to reduce the amount of preventable healthcare our citizens need in the first place. We want to make bold moves, and I know Louisianans have the spirit to take up that challenge!