Frederick P. Cerise, M.D., M.P.H.
Introduction: Mr. Chairman and members of the committee, thank you for the opportunity to testify today on the future of veterans’ health care in south Louisiana. I am Dr. Fred Cerise, Secretary of the Louisiana Department of Health and Hospitals (DHH), the leading state agency for health care in Louisiana.
Louisiana and the Department of Veterans Affairs (VA) have had a successful relationship for many years as demonstrated by collaboration among the Department of Veterans Affairs-Southeast Louisiana Veterans Health Care System (SLVHCS), Tulane University Health Sciences Center, and the Louisiana State University (LSU) Health Sciences Center.
Further, the LSU Health Sciences Center Health Care Services Division, which operates the system of public hospitals and clinics in Louisiana, and the SLVHCS have similar missions to provide primary and specialty care and other related medical services to their target populations. The two systems have several other things in common: both are public health care systems, both provide a high volume of outpatient care, and both are integrated systems. Additionally, physicians and residents from Tulane and LSU regularly rotate between the two systems.[i]
Post-Hurricane Katrina, these two health care systems, and ultimately the state and federal governments, have a tremendous opportunity to advance and strengthen this relationship into a formal partnership, creating better and more efficient health care for the citizens and veterans of Louisiana.
Louisiana Health Care Redesign Collaborative and the VA Vision: After Hurricane Katrina, the Louisiana Health Care Redesign Collaborative was created through a legislative resolution to respond to the health care issues in the New Orleans region (Jefferson, Orleans, Plaquemines, and St. Bernard Parishes). The Collaborative was a forty member group charged with creating recommendations for a quality driven health care system for New Orleans. The Collaborative adopted the following vision: Health care in Louisiana will be patient-centered, quality-driven, sustainable and accessible to all citizens.
The backbone of the redesigned system of care put forward by the Collaborative is the “medical home.” The goal of the medical home is to provide a coordinated approach to patient-centered care that is built on partnerships, to utilize health information technology, and to improve health outcomes. This is akin to the VA Vision that “supports innovation, empowerment, productivity, accountability, and continuous improvement. Working together, [you] provide a continuum of high quality health care in a convenient, responsive, caring manner – and at a reasonable cost.”[ii]
The medical home is the base from which primary care and other needed services are managed and coordinated in order to provide the most effective and efficient care. This includes specialty care, inpatient care, community preventive services and extension services for complex care needs. Investments in health information technology (HIT) and the recently established Louisiana Health Care Quality Forum (LHCQF) will aid in creating “system-ness” and ensuring that improvements in quality occur.
The medical home system is consistent with recommendations made by a number of professional societies. Additionally, it has the qualities and expectations consistent with those of a high performing health system and/or redesigned system as described by the Commonwealth Fund and the Institute of Medicine. Ensuring the coordination and comprehensive approach of the medical home model over time will improve the efficiency and effectiveness of the health care system and ultimately improve health outcomes.
Louisiana is moving forward with the redesign of the health care systems in the hurricane affected areas. As a result of the recent legislative session, funding has been allocated to pilot the medical home system of care, including support for the development of regional health information exchanges, adoption of electronic medical records by providers, and the LHCQF.
The VA as a Model for Health Care: In July 2006, BusinessWeek magazine called the VA health care the best medical care in the U.S. A 2004 article in The American Journal of Managed Care stated that “today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.”[iii]
The VA system is probably best known for its successful coordination of care and use of health information technology (through the VistA system). The Veterans Integrated Service Networks (VISN) created fundamental change in how health care was delivered to veterans. The VISN encouraged the coordination of care and resources of the medical centers, clinics, long-term facilities and other facilities. As a result, the VA experienced a reduction in hospital and long-term beds, and ultimately in hospitalizations.[iv]
Health information technology is integrated in the VA system through its VistA system. The success of the VistA system was highlighted in the aftermath of Hurricane Katrina when VA facilities across the nation were able to access patient information for evacuees. Health information technology provides the VA an opportunity to monitor and improve quality. For example, the VA uses computerized physician order entry, which has shown to decrease rates of adverse drug events.[v]
The VA also provides an avenue for health care research. In New Orleans alone, the VA has twenty-nine active research projects and is the home to the Mental Illness Research, Education, and Clinical Center.[vi] Furthermore, the cost per patient in the VA system is less than the national average.[vii]
The State’s Commitment to the LSU-VA Partnership: The state’s goals for health care are clear. Given the similar mission and goals between the state and the VA, a joint partnership between the two entities makes sense. What has been proposed is a move from three separate inpatient facilities that existed in New Orleans prior to Katrina to a single shared LSU-VA inpatient facility with a more dispersed network of clinics. Sharing of common physical plant needs and certain high-end clinical services will create significant operational efficiencies for our taxpayers and improved health benefits for all of the citizens we both serve.
The state’s commitment to this partnership is strong. The state has made the necessary commitment of funding for a new academic medical center in downtown New Orleans to replace the old Charity Hospital. Governor Kathleen Blanco recently signed Act 203, which allocates an initial $74.5 million for land acquisition and planning for the project. The authorizing legislation for the $225.5 million down payment called for in the business plan developed by Louisiana’s Division of Administration was approved by the state legislature and is awaiting the governor’s signature. The remainder of the project will be financed through general revenue bonds.
In addition to the state’s investments in the medical home pilots, HIT, and quality, the state has also committed $38 million to a cancer research institution, which will be established in downtown New Orleans. The presence of LSU and Tulane, combined with the VA and the new cancer center will create a medical district that will not only drive economic development in New Orleans, but will also provide state of the art health care to our citizens and veterans.
There is widespread support for this endeavor. The Regional Planning Commission for Jefferson, Orleans, Plaquemines, St. Bernard and St. Tammany Parishes unanimously endorsed a resolution supporting the retention of a VA Hospital in downtown New Orleans. The Downtown Development District of New Orleans passed a similar resolution. The state legislature showed its support of the LSU-VA partnership by passing Senate Concurrent Resolution 76.
The Unified New Orleans Plan (UNOP) identifies the LSU-VA partnership as one of its highest priorities for economic development. Input for the plan was received from every neighborhood in New Orleans and from a broad spectrum of community leaders. The Plan states that “the LSU/VA/University Hospital Complex is the key project to the reinvigorated medical district…it will foster technologically-driven high performance companies that have the potential of creating quality jobs and economic diversification.”
The state and the VA have similar visions for health care – to provide patient-centered, coordinated care that utilizes health information technology and improves health outcomes in the most efficient manner possible. The existing partnerships among the VA, Tulane, and LSU will only be strengthened through this proposed new model. Hurricane Katrina was a tragedy for the New Orleans region and for our country. Together, we have the opportunity to create something positive, new, and innovative in the wake of this terrible disaster.
The shared inpatient facility with a dispersed network of clinics organized to better serve our citizens is not a simple rebuilding of old systems but the creation of a new model that makes sense for those receiving care and responds with clinical and financial accountability to the taxpayers supporting this care. I urge you to recognize the opportunity to do something truly innovative for our citizens and support this endeavor.
Thank you for the opportunity to testify today.
[i] LSU-HCSD, Status Report: LSU/VA Collaboration in New Orleans, May 2006.
[iii] Perlin, Jonathan, et al, The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care, The American Journal of Managed Care, November 2004.