Member Spotlight

Louisiana Department of Health & Hospitals

by Illysa Schrager

 

Under the Louisiana Department of Health & Hospitals, Office of Public Health, Bureau of Family Health, Louisiana’s Family Planning Program (FPP), serves many of the state’s most vulnerable, high-risk patients across the state. In 2013, the program served more than 33,000 patients, 88% of whom had incomes under 101% of the federal poverty level (FPL). The FPP is administered by a core team of reproductive health professionals and several cross-functional staff members who work in epidemiology and outreach and enrollment. The program leads the health department’s clinical services and works closely with the Office of Adolescent Health, Teen Pregnancy Prevention, maternal and child health programs, Bureau of Primary Care, practice management program, and the state’s new Office of Health Information Technology (HIT). The program prides itself on its lean but strong workforce and its capability to leverage important resources and partnerships that help expand staff expertise and improve the quality of services it provides its patients. 

The public health system spans nine regions across the state, with a medical director in each region who oversees all clinical services. Family planning clinicians have collaborative practice with the medical directors, and receive day-to-day operational and clinical assistance from the regional medical director. Each parish, which is equivalent to a county, is home to a health center that receives tax-based support from the state, known as a millage. The amount varies greatly depending on the area. Reproductive health services are not provided in every parish health center; however, FPP provides nurses and/or clerical support of some sort at each site. The FPP program operates in 64 health centers across the state. The majority of services at FPP sites are provided by registered nurses (RN). The system also has 16 advanced practice nurses (APN) who travel to the health centers and are responsible for all LARC insertions and comprehensive physical exams including patients’ well visits. There are more than 50 RNs who have advanced scope of practice and are able to perform comprehensive sexually transmitted disease (STD) screening and treatment, under the supervision of an APN. 

The program is consistently working on its service provision model, and now operates its health centers through a more comprehensive, streamlined model of service. The system has a lot of long-serving providers, so it has taken time to onboard the network to the new model, but the program is making strides. To achieve a successful transition, the system is modifying its intake forms, billing procedures, and counseling to ensure patient confidentiality, and is preparing best practices particularly for adolescent confidentiality. Administrative staff is evaluating the system’s largest barriers, which consistently are hours of service and transportation, particularly in rural areas of the state. The program is in the process of considering staggering hours for health center operation, for weekdays and weekends, and is exploring whom to partner with to help communicate the possible change in hours. After seeing an uptick in the number of patients with syphilis, FPP integrated its family planning with STD services to ensure all patients are being appropriately screened for STDs. 

To address health disparity issues facing communities across the state, the administrative staff works with a number of organizations to better understand the local landscape. Providers have implemented best practices based on cultural insights and are becoming an agent of change for improving health outcomes. The Bureau Director has been very supportive of the program’s efforts, spearheading conversations at the state and national level. FPP staff knows that this work will be ongoing and are working on a multiyear, long term approach for determining how to best support providers and their patients and achieve health equity. 

When the new Quality Family Planning (QFP) guidelines were released last spring, FPP began to train its staff across its nine regions on implementing the guidelines into practice. The administrative staff made the guidelines readily available to providers and non-clinical/front office staff. Every staff member at provider sites was required to review the guidelines and offered continuing education credit, when applicable, for doing so. Administrative staff visited every provider site in the network and conducted face-to-face training with staff that focused on how the new guidelines impact service provision. They also offered webinars following the in-person trainings. The program updated the necessary clinical tools, including various checklists, medical eligibility wheels, updated medical manuals, office protocols, and other medical forms to conform to the updated QFP guidelines. Ready access to these tools helped health center staff “hit the ground running.” After the first round of in-person QFP trainings were complete, the training staff delved deeper with additional trainings on sexual violence and mandatory reporting, as well as quality counseling. The program staff felt it was vital to do these trainings in-person, as the interaction between the clinical and office staff was invaluable and helped staff more clearly understand the QFP. Program staff used multiple methods of education and communication and found that using case studies was particularly helpful for their providers.

Louisiana recently transitioned from a Medicaid Family Planning Waiver to a State Plan Amendment (SPA). Both the Medicaid expansion under the Affordable Care Act (ACA) and the SPA has helped open the door to serve an entirely new population of uninsured. In preparation for designing the SPA, FPP staff raised several issues they had with the waiver, with the hope of creating better coverage in the new plan. For example, STD screening was covered under the waiver, but treatments were not, and services were not covered for males. While there was strong interest in strengthening pregnancy prevention programs, to influence other related health outcomes, other benefits would also need to be covered. Staff worked with the state’s Office of Medicaid on billable services and treatment methods they wanted to be included. The FPP staff produced the content for the application, and the Office of Medicaid completed the direct application process and communication with the Centers for Medicare and Medicaid Services (CMS). 

The SPA was eventually approved, and FPP staff is now working with the state’s Office of Medicaid to ensure that providers are educated about the new areas of coverage. Staff has also developed a suite of material that providers share with their patients to help ensure they are educated about their full coverage options and understanding the enrollment process. 

Title X-funded health centers in the FPP network saw the most patients under the Medicaid family planning waiver, and FPP staff is hoping to grow the number served under the SPA. FPP staff has been meeting with the Louisiana Primary Care Association and with FQHC and community based systems to coordinate and ensure that the SPA is being utilized in various provider settings. Program staff is excited about the opportunities for outreach and education around the new SPA, particularly to male patients.

FPP has been working diligently over the last year to purchase, and now implement, a new electronic health record (EHR) system. Staff has been working closely with the Louisiana Healthcare Quality Forum and state and national extension centers throughout the process. FPP is currently piloting an EHR management system called Greenway’s Success EHS and has plans to fully launch the system in May. Staff has invested a great deal of time into the planning and implementation phase of the project and has contracted with the Louisiana Public Health Institute to ensure that the QFP guidelines are correctly reflected in SuccessEHS. 

Last year, FPP received an HIT grant from the Office of Population Affairs which has been used to update the equipment system-wide and will support the coaching and training with staff for the new system. Staff has been coordinating with FQHCs and other public health entities across that state that are already using SuccessEHS, which has helped guide staff throughout the planning and implementation process. The partnerships have helped educate the providers about the new system, share tools for providers to use in the system rollout, and help providers anticipate the impact the rollout may have on patients as the system falls into place. The partnerships have proven to have large payoffs for FPP, and once SuccessEHS is fully implemented, they plan to join the Louisiana Health Information Exchange to continue partnering with other health systems across the state. FPP is looking forward to seeing how SuccessEHS will affect their system-wide patient flow, billing and coding, and ultimately their entire revenue cycle.

Even in the midst of many difficult budget years, Louisiana’s Office of Public Health has continued to make the FPP a priority in its budget. As with many other systems across the country, FPP is working to ensure that comprehensive reproductive health services are not only available in Title X-funded health centers but across the public health system in the state, and are growing their partnerships with FQHCs and hospital systems to make it happen. 

 

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