Louisiana Health Secretary Rebekah Gee on Tech-Driven Solutions to Storm Preparedness Developed After Katrina and How Expanded Medicaid Coverage Has Improved Population Health

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Mark Masselli: This is Conversations on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , we are seeing some interesting announcements
coming out of the Veteran Health Administration, V A Secretary, Dr. David
Sh ulkin , a former guest in the show is announcing plans to move towards more
interoperability in the VA Health System. He made the announcement at last
week's HIMSS conference that ’s the largest gathering of health information
techn ology introduced in the world .

Margaret Flinter: Well interoperability continues to be an ongoing the me at
HIMSS , t echnology developers , healthcare provide rs multiple sta k eholders
throughout the healthcare system a re still struggling with how to make tha t
happen . And the VA recently switched its Electronic Health Record to Cerner ,
and secretary Sh ulkin said they b id the contract that way in order to have a more
rapid push towards data interopera bility, which is really compatible with some of
their strate gic goals.

Mark Masselli: Secretary Shulkin talked about his goals for developing common
data standards to facilit ate interoperability using an open API structure.
Secretary Shulkin says , he is there to fix the problems in the VA and the open
data will allow him to identify problems sooner.

Margaret Flinter: Well, easy sh aring of public health data is something our gue s t
today is quite interested in , w e are re - visiting our conversation with Dr. Rebekah
Gee , s he is the Secretary of Health for the S tate of Louisiana . And at that time
that we spoke , her office was monitoring the devastating hurricanes in Texas,
Florida, and the Caribbean sharing what they learned in the aftermath of
hurricane Katrina . They have since launched a r obust Electronic Health Record
system to replace what was lost and it ’s really a communitywide solution.

Mark Masselli: S ince there will be more severe storms in the future , this is really
some good information for all of our listeners.

Margaret Flinter: And Dr. Gee will also talk about the expansion of Medicaid in
that state since the election of Governor, John Bel Edwards. Hundreds of
thousands of residents in Louisiana have gained health coverage and they have
already got some pretty impressive data on the impact that it ’s having on
population health, so we are really looking forward to that conversation.

Mark Masselli: As we are to o, Lori Robertson who stops by , s he is the Managing
Editor of F act C heck.org , but no matter what the topic , you can hear all of our
shows by go ing to chc r adio .com .

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Margaret Flinter: And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter because we love to hear
from you. We ’ll get to our interview with Dr. Rebekah Gee in just in a moment .

Mark Masselli: But first here's our producer Marianne O’Hare with this week’s
h eadline n ews.

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Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. No
go for Idaho, The Department of Health and Human Services has rejected an
attempt by the state of Idaho to offer a health insurance exchange plan that f alls
far short of the requirements for coverage under the Affordable Care Act. The
state was making a bold attempt to capitalize on the curre nt mood in
Washington. Idaho Blue even went so far as to c raft five , so called Freedom
Blue Health Plans in anticipation of HHS approval that offered a modicum of
c o v erage . While the Department of Health and Human Services didn't give
approval for the pl ans , t he White House said if they want to redesign those plans
to fit the definition of the short - te rm health plan , the administration ’ s response
might be more favorable . The Congressional Budget Office warned such plans
w ould send premium soaring for tho se buying the full coverage under the
Affordable Care Act.

Curvy girls , pay attention ! There is already a direct link between obesity and
heart disease, but now a study out suggest s a higher link when certain body
parts are large r . Research data from al most half a million women in England and
Wales show that wom e n with larger hips and waist had a higher inciden ce of
heart attack . But the risk was even higher for people who had an unusually large
waist circumference or a high waist - to - hip ratio, meaning their hips were much
wider than their waist. Finding s show that looking at how fat tissue is distributed
in the body, especially in women , can give more insight into the risk of heart
attack down the line.

Concussion is a known hazard to long - term cognit ive ability in kids who play
football or especially susceptible to head injuries. The n umber of kids making
tracks on the gridiron has fallen in this country due to better information on the
harms of concussion, especially on young athletes . That reality i s apparently
setting in with American parents, the number of kids playing school football has
dropped from 1.1 million nationwide in 2008 to just a little over a million. The
absence of these players may have avoided between 6700 and 14,000
concussions d uring the last football season . News about the hazards of sports
related concussions and long - term harm ha ve grown steadily since 2009. I am
Marianne O’Hare with these Healthcare Headlines .

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Mark Masselli: We are speaking to day with Dr. Rebeka h Gee, Secretary of the
Louisiana Department of Health, which overse e s the states public health
initiatives as well as Medicaid. Dr. Gee is also a practicing Obstetrician and
Gynecologist, hav ing served as Director of the States Birth Outcomes , she
earned her master’s in public health from Columbia University, her medical
degree from Cornell and did her r esidency at Brigham and Women's Hospital in
Boston. Dr. Gee , welcome to Conversations on Healthcare .

Dr. Rebekah Gee : Thank you , Mark .

Mark Masselli: Well, first of all we are so pleased to see that Louisiana seems to
be out of the direct path of hurricane Irma and w as spared of the worst of
hurricane Harvey , b ut you will have some significant experience with the effects
of massive storm with hurricane Katrina never far from mind . And I am
wonder ing if you could sh are with our listener s , what are the public health steps
that you've taken and what has your state done that other states should learn
from and preparing for these incredibly potent storms ?

Dr. Rebekah Gee : So well Mark for those who live d through hurricane Katrina,
their lives will be punctuated by before the storm and after the storm . You know,
there were many mistakes made , s ome of them were just because no city of that
size had endured a hurricane disaster of that proportion . You know, 25,000
individual s had to be evacuated post storm , a lmost 2000 people l o st their lives .

Since then what we ’ve found is a number of things , f irst and foremost develop ed
a network. In Katrina , there w as a lot of communication going in different
directions, but there was not the ability to confirm , there was not an ability to
coordinate. We now do, we have a central command , I have what we call our
E OC Operation Center where we coordinate all of the heal thcare activities for the
state. We are able to assist facilities with evacuation plans , make sure that they
have thei r generators , what they need , to weather the storm or to leave for the
storm, we’re able to coordinate.

We also focused on pre - storm eva cuation, so prior to Katrina folks hadn’t
experienced that level of devastation , n ow we really insist that everyone leave ,
a nd we have a very r obust m edical i nstitution evacuation plan that includes
making sure that every facility has the ability to evacua te . So we now have
medical special need shelters, so prior to the storm, we would have medical staff
that would show up and assist in the general shelters . So what we learned, that
you have a lot of vulnerable individuals, some of them need a higher leve l of
care , a nurse to care for them during the day . And so we set up special need
shelters , w e have a mega shelter in Alexandria and we also have one in Baton
Rouge that we can set up and maintain and staff.

We also finally have much more r obust command of the data. We use our data

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to know where people are before the storm, who are fragile, we make sure that
they have an evacuation plan. So, w e have a much better handle on where
people are.

Margaret Flinter: Well Dr. Gee, we have issues related to peo ple having gone
without prescriptions , w e cannot ignore the mental health issues. Maybe you
could talk with us a little bit about what health issues you expect will a ffect the
victims of hurricane Harvey , and how are State Health Department s helping each
other really rise to the challenges that we think were obviously going to be seen
more of .

Dr. Rebekah Gee : Unfortunately with the climate changing on our globe, we
have to expect that these things may happen with more regularity and
unfortunately on the coast we’re all on the same boat . We were very fortunate
with Harvey that the storm did not hit Louisiana, so we were in a very good
position to help our brothers and sisters in neighboring Texas. Around 95% of
the people who came into our shelter s are Texas resident s , s o when we look at
folks , the most common thing that happens , and we saw this in the flooding in the
Baton Rouge area last August is that individual s lea ve quickly , t hey leave with out
their prescriptions , without durable medical equipment . And so we have now
plans in place to make sure that they are able to refill their prescriptions even if
they are not d ue . And we work out the ability to cross state lines in terms of
providing medical care , u nfortunately , we get to d ust off this plan to a little bit
more regularly than we would like .

Mark Masselli: You know, I am wondering, have you seen any technology
assistors out there that might be helpful to managing populations and keeping
track of them. Is there anything new in terms of technol ogy that might also give
some assistance ?

Dr. Rebekah Gee : S ure . So we ’ve seen significant advance s in healthcare
technology and particularly with record keeping, because the most important
thing in a storm is knowing where your vulnerable population is . So we now have
a single point of entry to report medical assets and also to report medical needs ,
w e have a registry that identifies where every vulnerable individual is and areas
that are high risk . And so the advances in IT infra structure with a sing le data port
of entr y allow s us to know where people are and it also allow s hospitals to report
their capacities, whether the ir generators are up and running , h ow many beds
are filled at that particular hospital so that we can plan in the condition of an
e vacuation, grant management system , post storm, so that we know where the
moneys are coming in and how to distribute them. So we’re much more
prepared from the data standpoint .

Margaret Flinter: Dr. Gee, we had former Louisiana Health Official , Dr. Kare n
DeSalvo on the show. She talked about one of the casualties of Katrina and how
the state rebounded from what was the loss of certainly millions of paper health

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records and said that it ’s sp urt [PH] a dramatic shift in your state to the use of
Electronic Health Records . And others talked about the impetus that Katrina
gave to really developing a more r obust primary care system, really implementing
a stronger primary care structure , I mean, if you ’d like to share with us a little bit
about some of the pro gress in that area.

Dr. Rebekah Gee : So in the wake of Katrina, we developed new and r obust
primary care facilities in the New Orleans area , but I think more important ly was
the decision that Governor Edwards made and which was to expand Medicaid.
Here in Louisiana , we have a large number of working poor folks who one in four
of them were uninsured, no way to access primary care except for, you know , if
they went to a charity facility or an emergency room . Now nearly 440,000 adult s ,
many for the first t ime in their li ves have access to primary care and we know
that over a 100,000 of them have received preventive health services . Tens of
thousands have gotten a colonoscopy, 19,000 women have gotten diagnostic
breast imaging, 3000 adult s being treated for diabetes over 30,000 were treated
for depression and mental illness . And that ’s something that we realized post -
sto r m when they have to lose the ir homes, lose everything they worked for, that
sometimes potentiate s the mental illness and stress . And so h aving a whole
system of care for them where they have insurance, can go to a federally
qualified health center, have a medical home and that has been a real sea
change for Louisiana.

Mark Masselli: We're speaking with Dr. Rebekah Gee, Secretary of Louisi ana
Department of Health which overse e s the states public health initiative. Dr. Gee,
another storm is brewing in the arena of health policy in this country , w e watched
just the congressional leaders and the White House attempted to repeal and
replace the Affordable Care Act . I am wondering what your thoughts are about
that , and as you mention ed Governor Edwards really stands out as a real leader
in making the expansion you talked about , t ell us about the state's infrastructure
to manage 400,000 , what str ain does that put on the system ?

Dr. Rebekah Gee : So, w e have had actually very excellent result s in terms of
primary care visit s in the first year and a half of our program. We have made
sure that our manage d care companies assign every member to a pri mary care
practitioner . We ’ve done education to make sure the people know that they have
an opportunity to receive primary care . W e are in the middle of working on a
s ystem of care we design ed that ’s focused on primary care . We are looking at
hospital r ates and things that w ould potentiate our ability to incentivize primary
care including looking at Accountable Care Models . On the legislator front, w e
are seeing that the Federal Overhaul Legislation ha s failed seeing the 11
g overnor s including my own Jo hn Bel Edwards, who signed a bipartisan letter
talking about the fundamental principles for health reforms , a nd I am very
optimistic that the bipartisan spirit will continue. What we ’ve seen out of the
federal proposal so far is very disappointing , w hat t hey don't address are the
fundamental drivers of c ost . What I see a s the biggest challenge is the overall

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cost of care, we spend double what other countries spend on healthcare and we
do n’t have as good of an outcome. We have poor diabetes and we have po or
obesity numbers and our behavioral health problems a re more r obust.

So we are failing to deliver prevention care and we are failing to deliver health, so
we need to deal with some of the fundamental c ost drivers , o ne of the major
ones is pharmaceutical c ost . Right now, the tax payer has to shoulder the
burden of whatever pharmaceutical industry wants to charge for their drug t hat
results frankly in lack of treatment and/or higher cost to the healthcare system
because the pharmaceutical prices are just so high . So we are addressing that ,
we are working with the National Governors Association on some work that
would lead to some different proposals for some of th ose drugs that are really
common, a good example is Hepatitis C where you have -- in our stat e 70,000
people with Hepatitis C and in the Medicaid program, we only treated 320 of
them last year. People also spend a lot of money at the end of life and for care
that they might not even want . You know, people tend to want to die at home,
but we do a ll sorts of very intensive things to them at the end of their life.

So, what we really need is a very r obust discussion about what we can do to get
the cost of healthcare down , w hat happened in the Congress this year was really
a discussion about block gr anting and other mechanism s that would
fundamentally result in decreased coverage and in millions of people losing their
healthcare. Let ’s focus on the things that would bring greater value to this
discussion like how do you cover these people a nd cover t hem at a lower cost ,
how do you promote healthy behavior s . And so t hese are all really important
discussions that I really look forward to having over the upcoming year.

Margaret Flinter: I want to look at something that I think has been a success and
c ause for optimism in Louisiana and that ’s the very successful public health
initiative that you have overseen is Director of the Birth Outcomes Initiative with a
goal to decrease infant mortality rate s statewide , and we would be really
interested in hearin g from you on some of the strategy and tactics that you
deploy to address birth outcomes.

Dr. Rebekah Gee : I ’m an obstetrician and co ntinue to see patients and so I was
asked to come up with some thing s that would move the state out of the 50th
grade [PH ] that we got and save baby’s life and to help deal with health
disparit ies and help deal with infant mortality. So, we s e t on a very strategic
course for things that would work to reduce prematurity and to reduce infant
mortality or the number of babies who die before year one. And we set about
statewide by educating hospitals, nurses, Primary Care Clinics about what they
could do , we spearheaded healthy babies that were to w ait along with the March
of Dimes which effectively ended the practice of electi ve induction s before 39
weeks in Louisiana. We worked on getting every wom a n progesteron e who
needs it , w omen who are high risk who ha ve had a preterm baby before , w e
were doing horrible at that. We have quadrupled the number of women who get

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progesteron e. We also focused on women who would have -- be healthy going
into a pregnancy and that women would time their pregnancies for when they
were ready. We had a 25% drop in infant mortality in Louisiana last year, that is
much higher than the national aver age of 15% drop over that time.

Mark Masselli: Congratulations.

Dr. Rebekah Gee : We made progress. There were 92 fewer African American
babies who died if stats had just continued in that way and a 160 overall fewer
babies who died during that period , so we were really proud of those results.

Mark Masselli: I know certainly the country as a whole is looking at the
devastating impact that the opioid crisis has had causing so many accidental
deaths in this country and that coupled with the obesity epid emic, which is
impacting a third of the nation's children . And I believe obesity numbers may be
somewhat higher in the South, but I am wonder ing if you could just talk a little bit
about how you are thinking about these to o chronic and complex health prob lems
and any strategies that you might have cross - walked over from the great results
that you were just discussing.

Dr. Rebekah Gee : Sure . Well , l et me start with the hard one , which is obesity.
We are the most obese state in the nation , t he number of obese people in our
state can fill our Tiger Stadium over 16 times.

Mark Masselli: Oh , wow .

Dr. Rebekah Gee : It's tough though, we have also some of the best food in this
country and in the world , p eople come here to eat our food . So this is the
be hav ior and behavior s are equipped to change, so our Wellhead Program was
recently awarded one of the national awards for best prevention program s of any
state h ealth d epartment in the country . And this designates well spots and
community organization s , busin esses that would like to be encouraged and
recognized for healthy behaviors and promoting healthy behaviors get a well spot
designation , so that’s been a great success. Another big challenge is smoking
frankly is, and the cost of caring for adult s who smo ke is tremendously high and
we still need to do a better job, getting smoking rates down. So, on opioids, we
have had tremendous success this legislative session because this has come to
such a head, we first started to see it a couple of years ago with i ncreasing rates
of what we call neonatal abstinence syndrome and the real crisis has really just
been mounting . In last year , f or example , on East Baton Rouge we saw more
overdose deaths stats and all motor vehicle death s and homicide death s
combined . An d so our legislature , our medical association and our Medicaid
program along with Blue Cross Blue Shield have partnered to do some very
powerful things. One is that we set seven - day limit. We know that 80% of
people who are addicted to heroin start on a n opioid, so part of it is just
decreasing the number of people that ever get a long - term opioid prescription

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and have a chance to get addicted. We also had created a 13 - member [PH]
advisory counsel on heroin and opioid prevention. We strengthened our
pre scription monitoring program. We also made mandatory medical training for
doc s so that they know the impact of the opioid epidemic and have more
education on addiction. You know, w hen I went to medical school, we didn't get
any training on addiction and addiction treatment , you know pain with [Inaudible
00:19:38] treat pain. We didn’t think a lot about the ramification s of our actions ,
w e prescribed opioids . So this is really a sea change in terms of mandatory
education and I think that ’s the result in m uch better outcome to the people of our
state.

Margaret Flinter : We have been speaking to Dr. Rebekah Gee, Secretary of the
Louisiana Department of Health. You can learn more about the Department ’ s
work by going to their website l dh.la.gov or you can fo llow Dr. Gee on Twitter
@r ebekah g ee md . Dr. Gee , thank you so much for the incredible work that you
are doing and for joining us on Conversations on Healthcare today.

Dr. Rebekah Gee : Thank you Mark and Margaret .

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Mark Masselli: At Conversation s on Healthcare, we want our audience to be
truly in the know when it comes to the facts about h ealthcare reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson : President Donald Trump made a reference to a ssociation h ealth
plans and short - term insurance when he boasted "we ’re having tremen dous
plans coming out now, healthcare plans at a fraction of the cost that are much
better than Obama Care . ” No such cheap plans have come out yet, but the
administration has proposed rules that would expand the sale of less expensive
insurance with fewer benefits. For some , cheaper plans with fewer benefits
would be better than those offered by the Affordable Care Act . For others,
particularly those with medical conditions, a plan with less coverage wouldn't be
an improvement. The proposed changes also could increase the price of
coverage for those who remain on the individual market and ACA exchanges.
Association health plans are created by a group of employers such as those in a
similar trade and short term plans are as the name says those offered fo r a short
period of time. The reason the plans would likely be cheaper is because they
wouldn't be required to cover certain benefits. The plans also could vary pricing
based on personal fact s such as age and gender and short - term plans could
price premi ums or deny coverage based on health status. Right now association
health plans that are sold to employers in the small group market must follow
small group rules , a n association health plans sold to individuals such as the self -

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employed must follow indiv idual marke t r ule. U nder the ACA p lans in those
markets must cover 10 essential health benefits and can only vary pricing based
on age limited to a 3 : 1 ratio, tobacco use, family size, and geography. Short -
term plans don't have to meet ACA requirements a t all including prohibitions
against deny or pricing coverage based on health status. The administration
acknowledges that the young and healthy are likely to sign up for the se short -
term plans leaving an individual market with a higher concentration of u nhealthy
and therefore higher cost individuals , and that's my FactCheck for this week. I
am Lori Robertson, Managing Editor of FactChek. o rg.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political pla yers and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you’ve a fact that you would like
checked, e - mail us at chcradio.com. We will have FactCheck.org’s Lori
Robertson check it out for you, here on Conversation s on Healthcare.

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Margaret Flinter: Each week Conversations highlight s a bright idea about how to
make wellness a part of our communities and everyday lives. It ’s a known fact
that the current generation of American children is more obese than a ny previous
generations . And at a Washington DC Community Health Center Unity Health
Care, a pediatrician was in a quandary over how to tackle this growing health
scourge. He began with the unique solution targeted to a teen patient whose
body mass index had already landed her in the obese category. What he did
was write a prescription for getting off the bus one stop earlier on a way to
school. The patient complied with the prescription and has moved from the
obese down to the overweight category. He then decided to expand this
program by working with the DC Parks Departments.

Robert Zarr : How to get there , p arking , i s parking available if someone ’s going to
drive bike racks ? There is a section on pets, park safety .

Margaret Flinter: Dr. Zarr writ es p ark prescriptions on a special prescription pad
in English and Spanish with the words “ Rx for Outdoor Activity” and a schedule
slot that asks, “When and where will you play outside this week?”

Robert Zarr: I like to listen and find out what it is my patients like to do and then
gauge the par k s I prescribe based on their interest s , based on the things they are
willing to do.

Margaret Flinter: He wants to make the Prescription for Outdoor Activity
adaptable for all of his patients and adaptable for pe diatricians around the
country. Rx for Outdoor Activity , partnering clinician s , p ark administrat ors ,

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patients and the families to move more yielding fitter, healthier young people, and
now that ’s a bright idea.
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Margaret Flinter: This is Convers ations on Healthcare . I am Margaret Flinter .
Mark Masselli : And I am Mark Masselli, peace and health.
Conversations on Healthcare broadcast from WESU at Wesleyan University,
streaming live at www.wesufm.org and br ought to you by the Community Health
Center.