In an overheated Holiday Inn banquet room Thursday morning, business leaders made pitches for privatizing a $2 billion slice of the state’s health care business.
United Healthcare, Amerigroup Louisiana, Louisiana Healthcare Connections and LifeShare Management Group are interested in managing the long-term care needs of 73,000 Medicaid-eligible people. LifeShare would work as a consultant and adviser to Louisiana Healthcare Connections.
The companies want to oversee the personal care, doctor’s visits, transportation, hospitalizations and other daily needs of people with disabilities, as well as those with age-related or adult-onset challenges.
For Gov. Bobby Jindal, it’s the remaining Medicaid chunk still largely run by state government amid his big push toward privatization. For the people fanning themselves in the banquet room Thursday, it’s their livelihoods.
Supported Living Network invited the businesses and the Jindal administration to its quarterly meeting in Baton Rouge. The Louisiana organization represents advocates for in-home help that keeps people out of institutions or nursing homes.
As one business leader bluntly put it Thursday, shifting people from nursing homes to community-based care — like a relative’s home or an assisted living facility — saves the state money.
What Supported Living Network members wanted to know is how rates and payment structures would incentivize home and community services.
In the state structure of long term care programs, 44 percent of Medicaid dollars goes to home- and community-based services; 55 percent goes to nursing homes and other institutions.
Last year, the Jindal administration outlined plans for serving more people at home with the dollars available. At the same time, community care providers have weathered rate cuts and service slashes.
“We’re not about the money. We’re about the quality of care,” Supported Living Network executive Bruce Blaney said at the start of Thursday’s gathering.
State Department of Health and Hospitals Secretary Kathy Kliebert said later in the day that the waiting list for state-supported, long-term care at home or in the community numbers 40,000 people. “The bigger goal really is to tackle our waiting list and get services for those who aren’t getting them,” she said.
Exactly what the Jindal administration has in mind will become more clear this summer, when it releases what is called a request for proposal. The RFP is a part of the contract bidding process in which companies are asked to describe the work they would do and how much it would cost.
Already, the governor has hired private companies to handle most of the state’s 1.4 million Medicaid recipients. Other privatization efforts focus on the management of the LSU public hospitals.
DHH Deputy Secretary Courtney Phillips told the Supported Living Network Thursday that 15 states had a managed care approach to long term services in 2013. In 2004, she said, only eight states had that approach.
The shift is delicate because of the vulnerability of the patients involved.
Nancy Herndon, vice president for business development at United Healthcare, said the fear is that people will be thrown out of nursing homes. She said it may work to move someone to their daughter’s home, into an assisted living facility or an independent home. Sometimes, a move might not be feasible, Herndon said.
“It’s keeping them out of the nursing home, not throwing them out of the nursing home,” she said.
Sonya Nelson, COO of Louisiana at Amerigroup Corporation, said the move toward privatization needs to be a collaboration. “We need you to tell us what works. Call us. Bring us to meetings. Communicate. We are a team,” she said.
Josh Boynton, CEO of Lifeshare Management Group, said the change offers the opportunity to look at the individual patient. He told a story about a patient who needed a wheelchair ramp to remain at home. A ramp was not on the checklist of available services.
“At the end of the day, it’s about outcomes. It’s about quality,” Boynton said. “If we’re not showing better outcomes, this isn’t going to work.”