Declaration of Secretary Michael O. Leavitt, United States Department of Health and Human Services, In Support of the Louisiana Healthcare Redesign Collaborative

Whereas, the mission of the Louisiana Healthcare Redesign Collaborative (Collaborative) is to develop and oversee the implementation of a practical blueprint for an evidence-based, quality driven health care system for Louisiana, to serve as a guide to health care policy in Louisiana and to the rebuilding of health care in the hurricane-affected areas of the state; and the initial mission of the Collaborative is to develop and submit to the U.S. Department of Health and Human Services a comprehensive system-wide Medicaid Waiver and Medicare Demonstration proposal for the Greater New Orleans area that will guide the rebuilding of its health care system; and

Whereas, the signatories to the Collaborative Charter (the Charter), which is being signed contemporaneously herewith, publicly endorse the need for major change in the health care system according to the Guiding Principles set forth in the Charter and the collaborative process for creating that change, the need to stay well-informed about the deliberations regarding change, and the need to be open to recommendations for change consistent with the Guiding Principles described in the Charter document and supported by emerging objective evidence; and

Whereas, U.S. Secretary of the Department of Health and Human Services (DHHS) Michael O. Leavitt similarly desires to encourage, assist and support the Collaborative in its commitment to the Guiding Principles, and the work of the Collaborative in expedited preparation of an appropriate, comprehensive, system-wide Medicaid Waiver and Medicare Demonstration proposal for the Greater New Orleans area that will guide the rebuilding of its health care system;

Now therefore, the Secretary declares as follows:

  1. Principles of Federal Support:

    DHHS' overall vision, which includes extensive input from local stakeholders, incorporates a highly functioning and sustainable health infrastructure that is capable of providing high quality care, in the right setting, when needed by the population. Principles for achieving that vision, which are consistent with the Collaborative's Guiding Principles, include:

    1. Assist Local Private Sector Efforts/Coordinate between Local, State and Federal Governments
      • Support existing, locally led, community-based mechanisms, offering expertise, when needed or desired, and taking action wherever possible to eliminate unnecessary impediments to rebuilding health infrastructure.
      • Deliver aid, to the maximum extent possible, through existing State, local and private entities, rather than through the creation of new Federal institutions or programs.
    2. Support Ambulatory and Community-Based Services:
      • Avoid investing in the rebuilding of ineffective services and systems destroyed by Hurricane Katrina,
      • Support strategies that strive to rebalance care toward ambulatory and community-based services rather than emergency rooms and institutionally based care, while providing efficient, effective care delivery for all residents
    3. Provide Higher Quality Care and Preventive Services:
      • Lend support to efforts that make the system more prevention oriented, advance the quality and value of health care, cultivate promising, evidence-based patient care improvements, and reward quality outcomes. This type of continuous quality management will offer the best possible return on investment for payers, providers, consumers and the public.
    4. Support Integrated Efforts to Improve Quality:
      • Encourage local communities to improve the quality and safety of health services by greater reliance on and sharing of electronic health information technology. Electronic record systems, emails, telemedicine, and other innovative approaches can help patients not only avoid costly complications, but perhaps even avoid the need for unnecessary health services.
    5. Support Personal Responsibility and Control:
      • Support the self-determination of evacuees, since individuals and families focusing on their own needs, resources and interests are far more likely to reach and/or obtain favorable results for themselves and for the broader society than when government restricts or directs their choices. To help people take more control of their health care, new initiatives should pay particular attention to supporting individuals directly, rather than institutions.
    6. Encourage Emergency Preparedness:
      • Mitigate the risk of future loss of life or liberty when necessary to achieve the common good by incorporating into the health care delivery system an all hazards approach for effective emergency preparedness for hospitals and other health care providers.
  2. Federal Role

    1. As the Collaborative is a locally-led, community based planning mechanism, the U.S. Secretary of DHHS will offer the Department's expertise, when needed or desired, and will take action wherever possible to eliminate unnecessary impediments to rebuilding health infrastructure.

    2. The U.S. Secretary of DHHS will share in providing direct support, guidance, technical staff assistance, contractual and other resources to analyze items or issues under DHHS' purview, all of which will facilitate the redesign effort.

    3. The U.S. Secretary of DHHS will provide staff to support the Executive Secretariat function of the Collaborative, and may designate others of his DHHS staff to serve as operational liaisons for the Collaborative.

    4. To the extent that the Medicaid Waiver and Medicare Demonstration proposal to be submitted to the Secretary is aligned with the Principles set forth above, are within the budget established for this initiative, and are within the Secretary's scope of authority, then the Secretary will consider approving such proposals.

    5. The Secretary will work closely with the Office of the Federal Coordinator for Gulf Coast Rebuilding, to ensure that appropriate and coordinated Federal support for rebuilding the Greater New Orleans healthcare infrastructure is delivered in an effective and integrated fashion and in a manner that is consistent with the Administration's overall efforts to rebuild in the Gulf Coast. If barriers to needed Federal support for rebuilding the Greater New Orleans healthcare infrastructure should arise, the Secretary or his designee will work with the Office of the Federal Coordinator for Gulf Coast Rebuilding and other appropriate federal agencies to ensure that such issues are considered and resolved appropriately.

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