Bayou Health gets high marks

Five private firms managing health care for about 900,000 Louisiana Medicaid recipients got high marks in an independent review required by federal officials.

The companies were in full or substantial compliance with state and federal requirements of the Bayou Health program nearly 100 percent of the time, according to IPRO, the firm based in Lake Success, N.Y. that conducted the review.

“Certainly it shows that Bayou Health is working well meeting the requirements we set out in contracts as well as those set out by CMS,” state Department of Health and Hospitals Secretary Kathy Kliebert said Friday.

CMS is the federal Centers for Medicare and Medicaid Services. “Each plan has about 900 requirements,” Kliebert said.

The external quality review analyzes and evaluates data collected related to quality, timeliness and access to health care services of the firms to Medicaid recipients enrolled in them. The review is done from a wide variety of perspectives including finances, core benefits offered, provider network adequacy, provider relations and handling of grievances and appeals, Kliebert said.

Each plan was rated separately with full or substantial compliance scores ranging from 96 to 99 percent.

“Bayou Health has dramatically increased access to new resources that better promote coordination of care and management of chronic diseases. The external review is an important indicator that what we’re doing works, and it is an important tool to use as we work to continually improve service,” Kliebert said.

The state contracted with IPRO to do the review. The federal Centers for Medicare and Medicaid Services is paying 75 percent of the $1.55 million three-year contract.

The Jindal administration embarked on the privatization of health care for two-thirds of its Medicaid population in 2012. Gov. Bobby Jindal said the private insurance companies could provide greater access to care while improving patient health both at less expense to the state. Eligible Medicaid recipients — mainly children and pregnant women — can enroll with one of five insurance companies to meet their health care needs. The companies contract with physicians, hospitals and other providers to deliver the care.

Three of the companies are paid a flat fee similar to an insurance premium with the ability to profit from any health care savings registered. The companies — Amerigroup, LaCare and Louisiana Healthcare Connections — all scored 98 percent full or substantial compliance in meeting 899 requirements.

Two other companies are paid for services rendered and share in any savings from reduced health care costs.

UnitedHealthcare Community Plan of Louisiana registered 99 percent full or substantial compliance with 740 requirements, while Community Health Solutions of Louisiana registered at 96 percent.