The report suggests an additional 30 million Americans will be obese in 18 years. This would cost an additional $549.5 billion on medical expenditures, according to the report in the American Journal of Preventive Medicine.  What does this mean for us here in Louisiana? It means we have to act now before our health care system becomes bankrupt and our next generation dies way before their time. So, the Governor’s Council on Physical Fitness and Sports (GCPFS) and the Department of Health and Hospitals (DHH) plans to unveil its strategy for tackling this very sensitive issue on June 7, and that strategy is the new Living Well In Louisiana Physical Activity and Nutrition Challenge—your complete online wellness center.

The Living Well In Louisiana Challenge encourages Louisianians to develop healthy activity and eating habits. Louisianans are encouraged to form teams of 2-10 people, or they can compete as individual participants. Kids and teens may have as many as 10-30 members per team. Well-known celebrities will join us in this 3-month Challenge:  Lolo Jones, a two-time World Champion in the 100m Hurdles and USA National champion will also be part of the USA Olympic team in London. Malcolm Jenkins, New Orleans Saints safety, Shaquille O’Neal, LSU Football coach Les Miles, former LSU basketball coach Dale Brown and many more have agreed to partake in the Challenge.

Team and individual participants can choose from one of the four challenges sponsored by famous celebrities:

The Healthy Workplace Challenge (Lolo Jones award)  is a race around London searching for clues in this exciting Get Fit Crime Mystery Challenge and participants can earn the

Family Challenge (Governor’s Award) is designed for you to do one activity with your family from the Family Challenge list and track it.  Choose from an indoor, outdoor and/or social activity daily.

Fit Schools Challenge (Malcolm Jenkins award) allows kids to race legendary explorers Lewis and Clark to the Pacific and back!  Watch their progress plotted on a map above as you progress on your own map!  See if you can beat Lewis and Clark to the Pacific North West and back by tracking 80 days of fitness!

Community Weight Challenge (Shaquille O’Neal award) allows you to watch yourself fly away to the moon in a shuttle, fly over the horizon in a hot air balloon as you shed those pounds and get lighter by the week, help Sherlock Holmes discover clues in London, and get healthy tracking your fruits and veggies! This challenge encourages healthy, sustainable weight loss (1-2 lbs. per week).

Living Well In Louisiana encourages participants to set realistic goals for a 3-month period and make informed decisions about health.  Living Well In Louisiana offers:

• A free pedometer upon logging on to LWLA for the first 1,000 participants.
• Living Well In Louisiana T-shirt after completing the program
• Chances to win prizes and incentives every week
• Weekly activity, nutrition and recipe tips via e-mail
• Personalized online dashboard to track your progress
• Team leader boards
• Personalized meal plans
• Customized workouts
• Community message board
• Calorie charts and MORE

Other Prizes: Starting in June, there will be weekly drawings for fabulous prizes, and the Living Well In Louisiana crew will continue giving away prizes every Friday until the end of the program. Winners will be announced on the Living Well In Louisiana Web site and by a special e-mail blast to all participants. The first 1,000 participants who sign up will get a free pedometer, and those who complete one of the four challenges will receive a T-shirt and certificate of completion.

The Challenge starts June 4 and we hope that you will join us to help reduce obesity in Louisiana by encouraging others to sign up and participate. Visit our website: livingwellinlouisiana.org and see all the wonderful features.

Go Well, Stay Well-

Rudy

Although the term “mental retardation” originated as a medical and clinical diagnosis, today it is commonly used as an epithet to insult or negatively characterize people or actions as being inferior.  The phrase “retard” or “retarded” is demeaning and hurtful to those with intellectual and developmental disabilities, their families and their friends.  Medical and health communities, which originally used the phrase to diagnose or label people, have recognized the hurtful nature of the R-word and replaced the phrase with terms like “intellectual disability.”  Regardless of what people mean or intend when they use the R-word, the effects on others can be devastating.  Its use can cause those diagnosed or classified with intellectual and developmental disabilities, and their families, to feel less valued.

I challenge each of you to be more mindful of your speech and stop using the R-word. When you hear others use the R-word, stop and take a moment to set a positive example. Explain to them how hurtful the R-word is. Do your part to make others aware of how their speech affects those around them.  When we join together to educate ourselves and others, we can make a difference, and we will end the R-Word.  Join us in in promoting the importance of acceptance, friendship, inclusion and utility by using the new R-Word, RESPECT.  Visit www.r-word.org to take the pledge.

I, Bruce D. Greenstein, pledge and support the elimination of the derogatory use of the R-word from everyday speech and promote the acceptance and inclusion of people with intellectual disabilities.

The purpose of the day was not just to rehash again the challenges our children face; rather, we spent the day digging deep into what is driving these results and where we need to focus our collective efforts. The dialogue was solutions-driven, with a focus on defining key metrics that represent opportunities to move critical dials to make tangible improvements quickly.

I want to thank John Paul Funes, the President and CEO of Our Lady of the Lake Foundation, for hosting our event at to the Corcoran Center.  I also want to thank Chief Justice Kimball for her leadership and direction.  We were also lucky to be joined by Dr. Robert Anda, the Senior Scientific Consultant for the CDC and Co-principal Investigator of the Adverse Childhood Experiences Study, who provided us with a data-oriented approach to evaluating the role of childhood trauma in predicting health and behavioral outcomes later in life.  Dr. Pam Monroe from LSU’s School of Social Work followed Dr. Anda with a discussion on the state of Louisiana’s children, bringing into focus the importance of caring for both the child and the family. 

Finally, leadership from the Departments of Education, Children and Family Services, Health and Hospitals and the Office of Juvenile Justice unveiled a critical component of this entire initiative: the Louisiana Kids’ Dashboard.  Leaders and team members from these state agencies have spent countless hours identifying the most significant data-driven outcome measures for children for inclusion in the dashboard. The Dashboard, consisting of 13 key indicators of child well-being, will be published online in February. Then residents, researchers, families and stakeholders will be able to see first-hand our progress in to improve children’s well-being. 

After these presentations, more than four hours were dedicated to both large and small group discussions.  Stakeholders from public, private and nonprofit entities from around the state sat engrossed in conversation, listened to a myriad of perspectives and ideas, provided feedback and laid the groundwork for future collaboration.  It truly was a great moment in the work being done to improve outcomes for Louisiana’s children.

Doing nothing was not an option. Louisiana has long been on a predictable path toward failure. Just this week, the United Health Foundation once again ranked Louisiana as the second least healthy state in the nation. I believe our potential is more than 49th place. We have great providers and passionate leaders, but moving the dial on generations of poor health outcomes is no easy task. It requires a fundamental change in the way we do business. For the last four years, scores of dedicated individuals have been researching, designing, building and implementing an entirely new approach to care for Louisiana Medicaid and LaCHIP recipients. While we’ve had significant public discussion throughout this process, I understand it is only too easy to lose sight of the forest through trees. Therefore, it occurs to me that not everyone may fully understand the strength of the program we are launching.

A recent article in The Economist talked about how states are continuing to expand or (as in our case) introduce Medicaid managed care as means to bring smarter management and better coordination to their soon-to-be expanded Medicaid programs. At the very end was the following statement, “If states do not draft their contracts properly, or fail to be vigilant in monitoring patients’ health, their experiment in managed care could be a disaster. On the other hand, if states are careful they could provide an answer to the question that has vexed America for years: how to provide good, cheap health care.”

And here we find Louisiana’s great advantage. I understand fully, from first-hand experience in other states, what the first part of that statement references. As with many programs, the early days of Medicaid managed care had their challenges. States made mistakes, and health plans took advantage of them. There were surely successes, but it’s the failures that remain firmly planted in the forefront of many people’s minds.  Louisiana is one of the last states with a large Medicaid population to implement Medicaid managed care, and we have built BAYOU HEALTH to be the standard-bearer of how to do it right and meet The Economist‘s challenge to find the answer.

Careful. Collaborative. Cautious. These are the words I’d choose to describe the process used to build BAYOU HEALTH. We learned from other states’ mistakes, incorporated best practices and, in some cases, designed promising practices that you don’t see elsewhere. From day one, our focus has first and foremost been on improving health; everything we have built into BAYOU HEALTH keeps that goal front and center.

As we finally move into the implementation and execution phase of this years-long endeavor, I felt it was important to reassure and remind our providers, partners and stakeholders of the strength of the foundation we are laying. What we are building together is the groundwork of Louisiana’s health renaissance-the chance to make impactful change that will last for generations. So, below are 13 points I believe are the differentiators that will make BAYOU HEALTH the model that other states look to emulate. They underscore our intense focus on health outcomes, quality measures and consumer engagement. I am proud of our work together, and these are just the top-line highlights that make BAYOU HEALTH stand above all other Medicaid Managed Care programs.

1. Quality Focus. With Health Plans reporting on 37 clinical quality measures, additional administrative quality measures and a portion of the capitation payment and shared savings contingent on meeting quality benchmarks, the focus on quality is obvious. We already have an External Quality Review Organization contract in place with national quality review organization IPRO. They have provided the framework for completion of the operational Readiness Reviews for each of the five Plans to assure that all contract requirements are addressed and met.
2. Encounter Data. We have made it very clear from the start (based on lessons learned from other states) that Plans must submit timely and accurate encounter dataon a monthly basis to our Fiscal Intermediary. We have builtstiff monetary penalties for failure to do so into the contracts.Some states are still not getting valid encounter data from their Medicaid managed care plans, in some cases many years after implementation.
3. Risk Adjusted Premiums. We are using the Johns Hopkins Adjusted Clinical Groupings (ACG) Case-Mix Model for our Risk Adjusted Premiums – something many other states don’t yet have incorporated into their Medicaid Managed Care programs at all and something we learned right away must be included to prevent “cherry picking” and “lemon dropping.” Plans that cover sicker individuals or those with chronic disease will be paid a higher per-member per-month for those individuals. This prevents health plans from having any advantage from cherry-picking their enrollees, and gives plans the resources they need to truly manage those conditions. The majority of state Medicaid Programs who do have full Risk Adjustmentuse a less sophisticated grouper that is not usedbycommercial insurance, that is static and not updated and relies on pharmacy data only.
4. Medical Loss Ratio (MLR) of 85 percent. A considerable number of state Medicaid managed care programs have no MLR requirementwhatsoever, or if they have one, there is no requirement for the Plan to refund the state the difference between the established MLR threshold and the actual MLR. BAYOU HEALTH Plans’ Annual MLR statements will be independently audited and results released to the public so everyone can know fully where tax dollars are going.
5. Robust Financial Reporting Requirements.The BAYOU HEALTH quarterly financial reporting requirements are extremely detailed and robust. You can click here to see the extensive  financial reporting we require – most of which will be published online. I have seen Financial Reporting forms for other state Medicaid managed care programs that pale in comparison.
6. Emphasis on Member Choice and Engagement. We have placed significant resources in outreach and education of members, promoting their awareness of BAYOU HEALTH and empowering them to engage in their own health care and that of their children. Great care has gone into every word contained in the written materials that will be mailed to enrollees: Readiness Brochure, Postcards and the Enrollment Packet, as well as ads, public relations pieces, posters, flyers and brochures. DHH-sponsored community enrollment events are planned in every parish (41 in the first Geographic Service Area alone over a five-week period). Medicaid eligibility staff is fully integrated into the education, outreach and assistance with Plan selection (a resource not even available to 90 to 95 percent of states since they contract with their social services agency to determine Medicaid eligibility). We have built incentives (and penalties) in the contract for our Enrollment Broker to reach certain thresholds of pro-active selection rather than having people auto-enrolled. The reality is we could have sat back and done nothing on this front and just assigned everyone to a Plan (some other states do Medicaid managed care like this). But we knew that for BAYOU HEALTH to have the impact we desire, recipients needed to engage in their health care in ways they have never done before. That’s why we have also included an aggressive outreach and education program for health care providers. Recent feedback we received from an individual who had seen our Provider Resource Guide said: “I appreciate your direction on creating such a consumer friendly process for the Medicaid clients.”
7. Monitoring Prior Authorization Denials & Appeals. Health Plans must reportand DHH will closely monitor monthly reports of all claims denied for reasons including 1) not meeting medical necessity, 2) not eligible on date of service, and 3) needs additional data. We will quickly detect and address any indications of inappropriate denials by a Plan. We will also compare plans, and the contracts include financial sanctions each time the Division of Administrative Law reverses a Health Plan appeal decision when the rate of reversals exceeds those of Medicaid fee-for-service.
8. Provider Network Adequacy. The BAYOU HEALTH staff will conduct ongoing monitoring to assure that prepaid Health Plans have continuous adequate provider networks including specialists. The Enrollment Broker will conduct monthly “secret shopper” surveys to confirm that physician appointments are available within the time and distance requirements outlined in the contracts.
9. Actuarially Sound Rate. DHH contracted with a leading national actuary with Medicaid expertise to establish actuarially sound rates for Health Plans. Our rates are realistic and sufficient to assure access and provider participation. Rates will be reviewed annually and adjusted upward or downward to assure Health Plans are not being paid “too much” or “too little”
10. Single System for Complaint Tracking. Our Enrollment Broker contract includes a requirement to develop and maintain a web-based application that will be used to record, track and analyze complaints related to BAYOU HEALTH in a single location.
11. Dual Models. Louisiana has not shown preference for either the MCO (prepaid) or PCCM (shared savings) model of managed care as both models are being implemented simultaneously with the benefit of first market entry in all 64 parishes. Providers and Medicaid/LaCHIP recipients have a choice of health plan models. This is unprecedented and for the first time provides the opportunity to truly compare costs and outcomes within the two models.
12. Medicaid Administrative Realignment. Louisiana Civil Service has signed off on a complete reorganization of our Medicaid staff to provide the necessary ongoing monitoring of the Health Plans, assess outcomes, organize data for public reporting and recommend modifications to the program if necessary. This is critical, as we have refocused our entire staff to manage and monitor BAYOU HEALTH while still providing core services under the remaining fee-for-service program.
13. Transparency. DHH will voluntarily publish and share BAYOU HEALTH metrics in ways that no other state has done. The list of all the reports is extensive.

DHH schedules BAYOU HEALTH provider Q & A calls

The Department of Health & Hospitals will host a series of conference calls Monday, Dec. 19, Tuesday, Dec. 20 and Wednesday, Dec. 21, to answer provider questions about the implementation of BAYOU HEALTH. Medicaid staff directly involved in the development of BAYOU HEALTH will be on the call to answer your questions. A brief introduction and update of the implementation will be provided by Medicaid staff, but the bulk of the conference call will be devoted to provider questions and answers.

DHH is asking that providers call in based on provider type, as noted below, to accommodate the limited number of call-in lines and ensure the most efficient use of call time. The conference call schedule is as follows:

• Monday, Dec. 19, Noon to 1 p.m. – Hospitals (Statewide)
• Tuesday, Dec. 20, Noon to 1 p.m. – Physicians (Statewide)
• Wednesday, Dec. 21, Noon to 1 p.m. – Other Providers (Statewide)

If you are unable to participate on your assigned date, you may call in on another date. The call-in information is as follows:

• Call-in line – #1-888-278-0296
• Access Code – #7299088

To participate in a conference call please register at www.makingmedicaidbetter.com by close of business, Friday, Dec. 16. During the registration you will have the opportunity to submit questions you would like answered during the conference call.

Plan Comparison Chart Posted

The official BAYOU HEALTH Enrollment website has been launched with many great features to help Medicaid and LaCHIP enrollees choose a health plan for themselves and their families.

One key feature that many people have been looking forward to seeing is the Health Plan Comparison Chart.

Feedback

If you have questions about BAYOU HEALTH, contact DHH’s BAYOU HEALTH staff at bayouhealth@la.gov.  Learn more and see the BAYOU HEALTH Plan comparsion chart at www.bayouhealth.com.

Preterm Birth is defined as less than 37 weeks gestation, and preterm births represent 15.4% of all births in LA in (2008). Louisiana ranks 48th nationally in infant mortality and preterm birth, and 49^th in the percentage of low birth weight and the percentage of very low birth weight babies, according to the National Center for Health Statistics. We have a high rate of disparity, with extremely elevated poor outcomes in Louisiana’s African-American population.

We also bear a financial burden associated with high labor and delivery costs.  Louisiana’s high prematurity rates are costly as the average cost for premature infants in Louisiana is $33,000 compared to a national average of $4,000 for term newborns (March of Dimes, 2010). With approximately 7,000 premature births covered by the Medicaid program, the excess costs to the state exceed $200 million annually.

Unfortunately, the March of Dimes 2011 Premature Birth Report Card released this month confirms what we’re well aware of. Louisiana has poor health outcomes – a fact we have worked tirelessly to change over the last year. The good news is that we have hospitals and providers who are dedicated to making the changes necessary to overcome the deplorable statistics that have plagued Louisiana for so long.

DHH implemented the Birth Outcomes Initiative in August 2010. It has several major components.

• We’ve asked all of Louisiana’s birthing hospitals to sign the 39 Week Pledge, vowing to develop, implement and enforce policies that prohibit elective, non-medically necessary deliveries prior to 39 weeks gestation. 46 (out of 59) birthing hospitals that have pledged to put a policy in place by January 2012. These hospitals represent over 85% of deliveries in the state. DHH will begin measuring 39 week deliveries in Louisiana’s birthing hospitals by January 2012.
• We’re also collaborating with the Institute for Healthcare Improvement (IHI) to provide 15 of the largest birthing hospitals in Louisiana tools to improve their perinatal care.
• We’re joining the March of Dimes in promoting the “Healthy Babies are Worth the Wait” campaign. This educational toolkit was designed to educate expectant parents on the difference a couple of weeks can make for a developing baby.
• We are collaborating with soon to be launching BAYOU HEALTH plans to promote best practices in behavioral health screening and treatment and preconception health to Medicaid-covered women at risk for a poor birth outcome. The purpose is to provide care coordination, health promotion, screening and interventions for women of childbearing age to reduce risk factors that might affect future pregnancies. Diabetes, hypertension, sexually transmitted diseases, obesity, smoking, heavy alcohol use and depression, for example, all affect a woman’s long-term health and can contribute to high-risk pregnancies and babies being born too small, too soon, or sick.

I want to take this opportunity to commend the hospitals and providers who have worked diligently in our fight against poor birth outcomes. Because the data used to grade states must be measured after the fact, it is going to take time for the changes we’re making now to be reflected in data analyses such as this one. Our goal is to make Louisiana the best state in the nation to have a baby. I am confident that once data from this year is collected, our grade will improve and reflect a healthier generation of Louisianians.

Last week, Senator Fred Mills joined me for a press conference at the Breaux Bridge Parish Health Unit where we I received my annual flu shot and we encouraged all Louisianians to do the same. All the same time, we held events in every other region of the state to ensure that everyone got the message loud and clear.

Each year millions of Americans get sick with the flu. In the United States alone, the virus kills more than 36,000 people sends more than 200,000 to the hospital each year. Your flu shot is the first and most important step in protecting against the virus. That’s why the CDC now recommends that everyone six months of age and older receive a flu vaccine as soon as possible.

Last year, less than half (48 percent) of Louisiana’s children six months to 17 years of age received the flu vaccine, below the national average of 51 percent.  Each year, 28 percent of school-aged-children get the flu. That’s nearly 1 out of every 3 kids! The flu keeps too many of our kids out of the classroom and inhibits their ability to learn and participate. I’m counting on Louisiana parents to step up to the plate and get their kids vaccinated this year.

Remember – we all own our own health. It is our responsibility to strive for health by taking the necessary preventive measures like getting our annual flu shot to keep ourselves and our family healthy.  Some people also say they don’t need the flu vaccine because they never get sick. The reality is getting the flu shot isn’t only about protecting yourself. It’s about ensuring the people around you, some of which may be at high risk for flu-related complications, aren’t exposed to the virus. If you don’t get sick, you won’t pass the virus on to coworkers, classmates and family members.

It is especially important to get vaccinated if you fall into one of the categories considered at high risk for flu-related complications. This includes young children; pregnant women or women who expect to be pregnant during flu season; people with chronic health conditions like asthma, diabetes or heart and lung disease; people who are morbidly obese; and people 50 years and older.

If your job is helping others, your first job is to protect yourself. Health care workers and people who live with or care for high-risk people should be vaccinated to keep from spreading flu to high-risk people. Children younger than 6 months are at high risk of serious flu illness, but are too young to be vaccinated. Parents, older siblings and people who care for them should be vaccinated.

Fear of needles standing in your way? That’s no longer an excuse. The flu vaccination is offered in two forms – the traditional shot and a nasal spray. “The Spray,”, which contains a live but weakened virus, is an effective vaccine that is recommended for healthy people age 2-through-49 years of age, who are not pregnant and do not have chronic illnesses. If you have questions about the nasal spray vaccination, be sure to consult with your physician.

Flu vaccines have been given for more than 50 years and they have a very good safety track record. Flu vaccines are made the same way each year and their safety is closely monitored by the Centers for Disease Control and Prevention and the Food and Drug Administration. Hundreds of millions of flu vaccines have been given safely.

Last, but not least, you can also help stop the spread of flu virus by developing some healthy habits.

• Cough and sneeze into your sleeve or a tissue and throw the tissue in the trash.
• Wash your hands often with soap and water, or use an alcohol-based sanitizer.
• Avoid close contact with sick people.
• If you’re sick, stay home for at least 24 hours after your fever is gone and limit contact with others as much as possible to keep from infecting them.

Remember, getting vaccinated not only takes a few seconds, it is virtually painless and many insurance companies will cover the cost. Flu shots are available at your local physician, as well as both chain and community pharmacists. For those unable to cover the cost of the vaccine, contact your local parish health unit. There really is no excuse; so this flu season, don’t chance it – get vaccinated.

Up-to-date flu information is available at www.FightTheFluLa.com and our Twitter and Facebook pages.

Here's my shot face - knowing I'll be protected from the flu this year is a great feeling!

The new brand will be used in an aggressive statewide education effort the Department is launching to inform Medicaid and LaCHIP recipients about the improvements being made in the Medicaid program through better coordination of care.

BAYOU HEALTH: Your Health, Your Choice is our way forward to improve health outcomes and build a healthier Louisiana. We know that coordinating care is a better approach than the outdated system we have sustained for far too many years. While our objective in developing BAYOU HEALTH over the past three and a half years has always been to improve the health of our enrollees, much of the public dialogue has focused on technical matters like contracts, actuarial analyses and payment methodologies. Now, we are refocusing that discussion back on people with our new name and multi-faceted education and outreach initiative.

Under BAYOU HEALTH, DHH has contracted with five different Health Plans – Louisiana Healthcare Connections, Inc (whose parent company is Centene); Amerihealth Mercy of Louisiana, Inc; AmeriGROUP Louisiana, Inc; UnitedHealthcare of Louisiana, Inc; and Community Health Solutions of America, Inc. These Health Plans will form networks of health care providers and care managers, and they will be responsible for coordinating health care for their members.

Nearly 900,000 of the state’s 1.2 million Medicaid and LaCHIP recipients will transfer to BAYOU HEALTH in three phases beginning Feb. 1. The first region includes the four-parish New Orleans-area region and the five-parish Northshore region, where enrollment into Health Plans for enrollees opens on Dec. 15. The two successive regions encompassing the remainder of the state will launch in 60-day increments following the first area of the state.

Recipients will initially have a 45-day window to choose a Plan and will be strongly encouraged to make a pro-active decision. Those who do not make choice will be assigned to a Plan based on a formula that takes into account which plans include their primary health care provider.

Some states who have moved to managed care just automatically assigned everyone to a plan, but we believe that our residents ought to be engaged in making an active choice. It isn’t the government’s job to pick what’s best for you and your family – we want you to make that decision. With about 80 percent of the people moving to BAYOU HEALTH being children, we especially need parents to be actively engaged in their children’s health care decisions.

That’s why DHH is working with community groups and organizations in every region of the state to educate enrollees about the changes and the need to be engaged. The education and outreach initiative will be multi-faceted and will begin about 30 days prior to the start of enrollment in each region. The initiative includes:

• Direct Mail
• Mass Media and Public Relations
• Outreach Events
• Direct Outreach Calls
• Choice Kiosks with Partner Agencies
• Engagement of Community Partners and Community-Based Organizations

The first mailing will go to recipients in the New Orleans and Northshore regions later this month. This “Readiness Kit” will tell people about the pending changes and encourage them to begin taking steps now to prepare for making a choice. Once enrollment opens on Dec. 15, there will be at least 41 large-scale events in neighborhoods throughout the region with several other smaller events. Local organizations have already signed on to partner with DHH to assist in educating enrollees, and these same efforts will be made in each area of the state as enrollment in that region begins.

To learn more about these exciting changes and stay informed, please visit the Department’s website – www.dhh.la.gov – where we’ll be posting regular updates.

We know that deliveries performed before 39 weeks for no medical reason have a greater chance of resulting in a cesarean section because the mother’s body is not as ready for the process of labor as they are at full term.  In addition to the risks to the mother which include longer labor and unnecessary cesarean sections, deliveries prior to 39 weeks pose significant risk to babies.  Babies born prior to 39 weeks are more likely to die in the first year after birth, have breathing and feeding difficulties and be admitted to the Neonatal Intensive Care Unit (NICU).  There are many good reasons why a doctor may have to deliver a patient before 39 weeks. However, unless there is a medical reason, these risks are avoidable and unacceptable.

DHH, through the Louisiana Birth Outcomes Initiative, has partnered with multiple groups across the state to ensure that these deliveries no longer occur in Louisiana.  LAMMICO, our major malpractice carrier for physicians, has created an educational program for doctors.  The March of Dimes is launching its “Healthy Babies are Worth the Wait” campaign in partnership with DHH to educate patients about the risks of these deliveries.  The Louisiana State Medical Society and Louisiana ACOG supports these efforts.  Finally, the hospital association that represents our own hospitals has recognized that this practice must end. Along with LAMMICO, they are helping to sponsor a statewide conference on October 18^th to discuss quality with the 39 week issue being a major focus.  Every hospital in the state that delivers more than 1000 babies a year has signed on to end this practice and many more are joining every week.  Hospitals are promising that by January of 2012, they will implement these policies.  For more information please go to the Birth Outcomes Initiative website at: www.boi.dhh.la.gov.  We look forward to partnering with you to make sure that our state becomes the best place in America to have a baby.  And remember, babies need at least 39 weeks for them to have the best chance at a healthy life.  Let’s work hard to make sure that EVERY baby in Louisiana has that chance.

The Louisiana Perinatal Care Improvement Summit is one of the Birth Outcomes Initiative’s efforts to empower Louisiana’s hospitals and providers to address quality improvement across the state.  We will highlight the partnerships cultivated by the Birth Outcomes Initiative and address how these collaborations have contributed to establishing a successful perinatal care network in Louisiana. Dr. Rebekah Gee, a brilliant physician and director of the Birth Outcomes Initiative, will also provide valuable feedback regarding the progress of our perinatal collaborations.  Dr. Frank Opelka, Vice Chancellor of Clinical Affairs at the LSU Health Sciences Center in New Orleans and a nationally recognized leader in quality improvement, will give a presentation on the national quality landscape. In addition, the director of the Institute for Healthcare Improvement, Dr. Virginia Crowe and the executive director of Childbirth Connection, Maureen Cory, will participate in an expert panel discussion on perinatal quality.  Finally, leaders from maternity hospitals across the state involved in the Perinatal Quality Collaborative and the 39 Weeks Initiative will share their own success stories with other maternity hospitals.

One of the Louisiana Birth Outcomes Initiatives’ key strategies is to foster a strong culture of quality improvement among our state’s maternity hospitals. The “39 Week Initiative” encourages every birthing hospital in the state to end medically unnecessary deliveries prior to 39 weeks. Thus far, over 30 hospitals in the state have signed on to this pledge.

I’m also proud to say that DHH is the first state health and human services agency in the country to partner with the Institute for Healthcare Improvement (IHI), a national leader in healthcare quality. Thus far, there are 15 of our highest volume hospitals participating in IHI’s Perinatal Quality Collaborative. Also leading the quality charge are our key partners, the Louisiana Hospital Association, Louisiana Medical Mutual Insurance Company (LAMMICO), the Louisiana State Medical Society and the Louisiana Chapter of the American College of Obstetricians and Gynecologists.

To find out more about our birth outcomes initiative, please click here. We have a lot of work to do, but if we work together as individuals, families, health care providers and policy makers, we can produce a healthier generation of Louisianans for our future.

This blog is one of many ways the newly formed Birth Outcomes Initiative (BOI) is here to serve you. Your knowledge and understanding of your health as a woman is vital to you, your family and even your community and we want to help you learn how you cultivate that knowledge and make the most of it.

The Louisiana Department of Health & Hospital’s Birth Outcomes Initiative was created to address the critical needs of our state’s women and children. Louisiana has one of the highest rates premature and low birth weights babies, predisposing them to illnesses like respiratory distress syndrome, heart disease, and sometimes even death. Louisiana currently ranks 49^th in the nation for infant mortality (babies dying at or soon after birth), preterm birth (born too soon) and in the percentage of low and very low birth weight (born too small) babies (National Center for Health Statistics, 2005, 2007). Additionally, Louisiana earned an “F” on the 2010 March of Dimes Prematurity Report Card, and at 38 percent, we have the second highest Caesarian-section rate in the country.

That being said, the DHH has started from the top to radically address and change these issues.  We’ve teamed with partners such as the March of Dimes, the American College of Obstetricians and Gynecologists, the Louisiana Hospital Association and the Louisiana State Medical Society just to name a few. We have developed a strategic plan implemented statewide to improve women’s and children’s health, and these plans are underway.

Most recently, area hospitals and physicians have pledged to end unnecessary inductions and cesarean sections before 39 weeks gestation (the age that is needed to ensure the best outcome for babies). Delivering prior to 39 weeks without a medical reason has been proven to put the baby at risk for those illnesses mentioned previously in this article.

Our mission is to improve the health of Louisiana’s moms and babies by making positive impacts on women’s health, infant health and hospital-based women and infant care. This blog is one way we plan to do this. Once a week, we, Dr. Rebekah Gee, Director of the Birth Outcomes Initiative and Dr. Regina McCutcheon, Birth Outcomes Outreach and Education Coordinator will address your women’s health issue. These include your reproductive life plan, sexually transmitted diseases, preconception, fertility, your menstrual cycle, diabetes, hypertension, obesity, smoking, substance abuse, depression, teen pregnancy — all of which affect a woman’s long-term health and can contribute to high-risk pregnancies and babies being born too small, too soon, or sick.

So Louisiana mothers & children, get ready. Get set. Go!

A healthier generation of women and children in Louisiana,

~Dr Rebekah Gee, Birth Outcomes Initiative Director

~Dr. Regina McCutcheon, Birth Outcomes Outreach and Education Coordinator

Please e-mail your questions to rmccutch@tulane.edu or rgee@lsuhsc.edu. Your question will be answered in the order in which it is received and may even be featured on the blog.