Recovering from disaster: The industry reflects on the impact of Hurricanes Katrina and Rita on healthcare delivery and e-health records

NATIONAL REPORTS-New Orleans officials recently announced that they believe the city has reached half of its previous population prior to Hurricane Katrina. Some of the city's hospitals have not reopened, and many doctors and allied health professionals have not returned to the city.

Following the catastrophic impact of major hurricanes, including Katrina and Rita, on the Gulf Coast in 2005, health plans and disaster preparedness experts rushed to rebuild an infrastructure ravaged by chaos. Several sources interviewed by MANAGED HEALTHCARE EXECUTIVE immediately after the disaster now say that in the months since, the storms' effects on healthcare in the region, much like the physical damage, have lingered in some areas, but have dissipated in others.

In the Gulf area currently, "there is a shortage of primary care doctors," according to Christopher Valerian, DO, MMM, executive medical director, Quality and Clinical Innovations, Horizon Blue Cross Blue Shield of New Jersey. "Many providers did not return to the area."

When MHE spoke with Blue Cross and Blue Shield of Louisiana (BCBSLA) in Baton Rouge at the time of Katrina, the plan was helping providers care for patients more efficiently by not requiring prior authorizations on covered services for covered members throughout the state. Today, as many as 75% of providers from Orleans Parish who were filing claims with Blue Cross before the storms are not currently doing so, says John Maginnis, vice president, BCBSLA corporate communications.

LEADING THE CHARGE

As the state's largest health insurer, with more than 250,000 insureds severely affected by the hurricanes, Blue Cross has taken a leadership role in rebuilding the gravely hit areas. BCBSLA CEO Gery Barry was appointed by Gov. Kathleen Blanco to the Public Health and Healthcare Task Force of the Louisiana Recovery Authority, the planning and coordinating body created for the recovery and rebuilding of Louisiana. Initially Barry led a workgroup on redesigning the healthcare system in that state. The workgroup has now evolved into the Louisiana Health Care Redesign Collaborative, headed by Fred Cerise, MD, secretary of the Louisiana Department of Health and Hospitals.

According to Maginnis, despite the enormous disruption caused by the hurricanes, 2005 ended well for BCBSLA. "We accomplished all key initiatives built into our business plan, including the first installation of our new core computer system and our company's successful participation in the new Medicare Part D program," he says. "At the same time, new sales and membership retention have remained strong despite the hurricanes. We ended 2005 with more than 1 million medical members. And on the financial side, we ended the year stronger than ever as well."

BCBSLA doesn't see major changes in healthcare delivery nationally as a result of the 2005 hurricanes. Maginnis believes a lot more attention is being paid to issues that were important before Katrina, but perhaps not at the forefront of the national conversation. "These issues include the need for a national electronic health record [EHR] system to help both patients and providers when people are separated from their medical records for any reason," Maginnis says. "The plight of the uninsured is getting more attention again as the media and experts from all over the country get a good look at the way healthcare was delivered in Louisiana before the storms. Problems with Medicare and Medicaid also are getting more attention; politicians are talking about healthcare financing, preventive medicine and wellness, and long-term care for the elderly or disabled whose families lack resources."

BCBSLA began offering most of its members and their doctors free access to their claims-based health histories by the first week of October 2005. "The initiative to provide a claims-based health history was already in place before the hurricanes struck," Maginnis explains, "but we dramatically accelerated their development to help meet the critical needs of displaced customers and their doctors. The health histories initially were available by phone/fax access, but we quickly expanded that to secure online access by mid-October."

MEETING EXPECTATIONS?

Anecdotally, industry experts agree that EHRs have helped individual doctors and patients, but there still isn't a true nationwide EHR system that contains all of the data necessary to effect real change in the way healthcare is delivered.