According to Karen DeSalvo, Commissioner of Health for the city of New Orleans, the state of Louisiana is generally viewed as a healthcare backwater.

And that was before Hurricane Katrina.

The eye of the 2005 hurricane did not make landfall in New Orleans, but flooding in the wake of the storm submerged large areas of the city, destroying property, displacing residents and crippling the city’s healthcare safety net.

DeSalvo spoke here Tuesday at the 2013 HIMSS Annual Conference & Exhibition, explaining the healthcare tragedy that followed Katrina and the steps the city has taken to rebuild its public health infrastructure.

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“Louisiana has consistently ranked 49th out of 50 states in healthcare status,” DeSalvo said. “Policy decisions were made not to expand healthcare access for the poor and uninsured, which leads to overuse of the emergency room, which leads to high cost, and low quality of care. This was all aggravated by the impact of Katrina.”

Charity Hospital was the nexus of healthcare for the New Orleans poor, DeSalvo said, serving a predominantly minority population through inpatient care, outpatient clinics and one of the busiest emergency departments in the United States. The hospital was flooded after Katrina.

Following the storm, New Orleans’ healthcare leadership made a commitment to rebuild the city’s healthcare system, with an emphasis on better serving the low-income population that the flood endangered.

“We devised a four-pronged blueprint for healthcare reform,” DeSalvo said. “We wanted to redesign the delivery system to focus on primary care, with a special emphasis on neighborhood-based care.”

Such a redesign was point number one on the blueprint. Also essential was improving quality of care, point number two. The Louisiana Health Care Quality Forum, a statewide public health partnership, was established by legislative mandate in 2007.  Point number three abetted the movement toward quality: support for healthcare IT tools that would aid providers in care delivery.

“The Louisiana state medical society did not support the use of computers in medicine in 2006,” DeSalvo said. “Now they are leading proponents of healthcare IT.”

The fourth point on the city’s healthcare reform blueprint has proved the most challenging: expanding coverage and realigning incentives.

“This has been very hard,” said DeSalvo. “We still have a healthcare marketplace that is essentially per diem for hospitals. There is no incentive to keep patients from coming into the hospital for care instead of seeing primary care providers. We have not been able to change those incentives and that is hurting primary care.”

In coming years, New Orleans intends to strengthen the primary care marketplace, which would include an emphasis on community health centers that could serve as medical homes. DeSalvo said it was inevitable that there would be an expansion of insured patients via healthcare reform, and primary care outlets must exist to fill the need.