Leaders from state health care organizations, employers, consumer advocacy groups and government met in New Orleans on Tuesday, Nov. 6, to discuss findings from a recent national study that ranks Louisiana 46th in the United States in terms of health system performance, and from a second study that attributes part of this poor showing to the structural characteristics of the States public and private health care delivery systems and provider practice patterns.

This gathering of leaders was the inaugural event of the Louisiana Health Care Quality Forum, a new private, not-for-profit organization whose mission is to lead evidence-based, collaborative initiatives to improve the health of the people of Louisiana. The LHCQFs volunteer board represents a cross section of public and private insurance purchasers, patient advocates, providers, physicians, and insurers in the state.

The reality of our current situation is that there has been a complex, systematic failure in health care nationally which is especially acute here in Louisiana, said Michael Fleming, MD, President of the LHCQF and past-President of the American Academy of Family Physicians. Our solutions must be implemented at the system-level, must come from stakeholders within our own State, and be focused as much on health as on health care.

Anne Gauthier, Senior Policy Director of the Commonwealth Fund Commission on a High Performance Health System kicked off the event by putting Louisianas performance in a national context. Gauthier presented results from the Commonwealth Fund report, Aiming Higher: Results from a State Scorecard on Health System Performance, which examined access, quality, avoidable hospital use and costs, equity, and healthy lives and found wide variations in the results achieved by each of the 50 states and the District of Columbia.

For instance, the Commonwealth Fund study found that even in the highest-ranked state only 50 percent of adults fifty years and older received recommended preventive care. Only 33 percent received such care in the lowest-ranked state, compared to 37 percent in Louisiana. Overall, according to the Commonwealth Fund State Scorecard, Louisiana ranks 33rd in access, 41st in quality, 51st in avoidable hospital use and costs, 28th in equity, and 50th in healthy lives.

In addition to wide variation between states, there are also wide variations within states. These variations were the subject of Dr. David Wennbergs presentation, titled Health System Improvement Opportunities in Louisiana: Analysis Through the Lens of Unwarranted Variation.

Dr. Wennberg is President and CEO of Health Dialog Analytic Solutions (HDAS). Prior to Hurricanes Katrina and Rita the Blue Cross and Blue Shield of Louisiana (BCBSLA) Foundation provided a grant to Tulane University to develop a snapshot of Louisianas health care status. Working with Dr. Wennberg and HDAS, health care claims from the three primary payers in Louisiana (Medicaid, Medicare and BCBSLA) were compiled to create an integrated, Multi-Payer Database Warehouse. Analysis of the Multi-Payer Database Warehouse forms the basis of the Health System Improvement Opportunities in Louisiana report.

Key initial findings from the Multi-Payer Database Warehouse project are:

• Large variations in the quality, cost, and utilization of care across regions within Louisiana cannot be fully explained by health status, insurance type, race/ethnicity or gender of the population.

• Higher insurance-based expenditures did not lead to better quality.

• The uninsured appear to use emergency rooms for chronic disease in lieu of other sources of care, suggesting a lack of access to primary care.

The report states that variations are likely attributable to structural characteristics of the States public and private delivery systems and the practice patterns and behaviors of providers within these systems.

These findings are consistent with those found in more than forty years of research nationwide grounded in the work of John Wennberg, MD, recently named by the health policy journal Health Affairs as the most influential health policy researcher of the past 25 years.

The LHCQF has embraced the perspective adopted by the Institute of Medicine, among other organizations, that poor outcomes are not the result of bad people doing bad things. Instead, as the Institute of Medicine has said, they are the result of good people working in bad systems. Through an arrangement with Tulane University, data from the Multi-Payer Data Warehouse will be made available to the Louisiana Health Care Quality Forum to further inform its quality improvement efforts. This tool offer opportunities to identify health care best-practice benchmarks for Louisiana.

While we know that data cannot prove anything, we hope that these studies will start conversations that will continue state-wide through the ongoing work of the Quality Forum and others, says Dr. Fleming. This event is one example of how we hope to pursue this challenge: involving and organizing a large group of committed individuals, soliciting a host of perspectives, analyzing and interpreting the data; and then working to move our organizations toward a consensus of what are the right things to do for Louisiana.

Submitted by Rob Anderson. Filed under Post-Hurricane Healthcare

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