10 years after Katrina, New Orleans has transformed primary care, behavioral health

The devastation of Hurricane Katrina 10 years ago presented New Orleans with the opportunity to re-imagine our healthcare system and determine how we could better provide care to residents.

Prior to this horrific storm, low-income and uninsured residents largely received care through the state-run public hospital system, particularly the flagship Charity Hospital in downtown New Orleans. While open to everyone, Charity was plagued by overcrowded clinics, long wait times, frequent budget shortfalls, and a centralized location inconvenient to many patients. Options for low-income residents were limited; most had no other choice but to rely on Charity, even for routine primary care.

Over the past decade, providers in the metro area have collaborated with a multitude of partners to develop a healthcare delivery system that surpasses the one that existed before the storm. While care has been provided in a variety of improvised settings including military tents, converted houses and a retrofitted former Lord & Taylor department store, this has changed.

Now we have a remarkably robust network of neighborhood-based primary-care and behavioral health medical homes that has arisen since Katrina. With the help of investments from foundations and the state and federal governments through grants and the Greater New Orleans Community Health Connection, a Medicaid demonstration waiver program, local organizations have greatly expanded their primary-care and behavioral health capacity, particularly in underserved communities.

Today, the greater New Orleans area is served by 22 organizations operating a total of 60 neighborhood-based clinics offering primary care, behavioral health and preventive services to approximately 140,000 patients irrespective of their ability to pay. Forty-two of these clinic sites are federally qualified health centers. All use electronic health records, many are certified patient-centered medical homes, and some cater to special populations such as at-risk youth, musicians or the homeless.

The majority of these health centers have same-day or next-day appointments, and all of them are dedicated to serving everyone who walks through the door. Also, our city recently celebrated the opening of University Medical Center, a $1.1 billion facility operated by local not-for-profit LCMC Health under a public-private partnership with the state.

In addition to providing indigent care, this spacious and modern complex will provide Level 1 trauma services to a 10-parish area and serve as a research hub, the academic training ground for two medical schools and a regional tertiary referral center.

While we are fortunate to have a state-of-the-art teaching hospital, our attention remains on continuing our transformation from a centralized healthcare system concentrated on reactively treating illness to one focusing on prevention, chronic disease management and coordinated care through a medical home.

However, this transition has not been easy.

New Orleans struggles with a high uninsured rate of 17%, which leads to residents forgoing needed care or delaying treatment until their situation is critical.

A lack of sustainable financing continues to threaten the community health centers since the state has not expanded Medicaid. An expansion would not only decrease the number of uninsured but provide consistent funding.

Educating a community long-reliant on a single, centralized health access point about using this new neighborhood-based clinic network—before their illness reaches a critical point—is challenging and requires creativity, interagency collaboration and new partnerships.

Also, access to certain preventive, diagnostic and specialty-care services remains problematic. For example, New Orleans needs increased dental services for uninsured and low-income residents to shrink the all-too-lengthy wait lists.

The city also needs to expand bilingual services to accommodate the growing Latino community.

Despite the many challenges, New Orleans has significantly improved access and delivery of healthcare for residents. With

an expanding network of neighborhood-based primary-care and behavioral health clinics connecting patients to a modern acute-care hospital and trauma center, we are continuing to build a better, more resilient healthcare system to meet the needs of our diverse residents so they are empowered to live healthy lives. Together we are proudly working toward a healthy community.