Navigant Consulting is the apparent winner of a $3.3 million contract to study options for redesigning the state’s Medicaid and PeachCare programs. The winning contractor...

Navigant Consulting is the apparent winner of a $3.3 million contract to study options for redesigning the state’s Medicaid and PeachCare programs.

The winning contractor will have the task of reviewing Georgia’s current managed care program — which covers more than 1 million Medicaid and PeachCare for Kids beneficiaries — and those models developed by other states.

The commissioner of the agency that runs Medicaid in Georgia, David Cook, has said he wants to take a comprehensive look at alternatives to the HMO-like structure launched by former Gov. Sonny Perdue.

Under that structure, the state pays three “care management organizations’’ a total of more than $2.5 billion a year to serve the Medicaid and PeachCare populations.

Chicago-based Navigant’s bid was judged superior to those of four other companies: Baker & Daniel Consulting, Mercer Health & Benefits, Myers & Stauffer, and Public Consulting Group. The state’s formal announcement of the contract is expected soon.

The Navigant contract is for one year, with two possible one-year renewals.

The $6 billion Georgia Medicaid program (including federal funds) faces continuing budget problems. It also confronts a huge expansion of Medicaid beginning in 2014 – perhaps 600,000 new enrollees – under health care reform, if the Affordable Care Act of 2010 survives court challenges. The Medicaid and PeachCare budgets passed by the Georgia General Assembly earlier this year reduced payments to doctors and dentists by 0.5 percent, raising concerns about patients’ ability to find medical providers willing to take new Medicaid patients. The budgets also instituted PeachCare co-pays, and increased those fees for Medicaid patients.

“We are concerned that recent changes to Medicaid and PeachCare for Kids, such as increased co-pays and provider reimbursement rate cuts, may provide short-term budgetary savings but come with a high cost in [reduced] access to care,’’ said Cindy Zeldin, executive director of the consumer advocacy group Georgians for a Healthy Future.

Zeldin said Monday that she hopes the Department of Community Health, when it does the redesign, will look at the best practices from around the nation ‘’to streamline enrollment, facilitate access to care, and improve health outcomes.’’

In recent months, leaders of medical provider groups in Georgia have expressed interest in North Carolina’s Medicaid program as a possible model for Georgia’s.

The Medicaid program in the Tar Heel State uses a ”medical home’’ concept. The state is divided into 14 nonprofit, doctor-directed regional care networks. Hundreds of care managers help patients stay healthy, visiting them in their homes and helping keep them out of hospital emergency rooms. Physician panels decide quality parameters.

North Carolina says it has saved millions of dollars annually with its Community Care program.

Commissioner Cook, at a recent board meeting of Community Health, expressed interest in Indiana’s program.

Healthy Indiana has a benefits package modeled after a high-deductible, health savings account insurance plan. It covers Medicaid beneficiaries and also low-income uninsured adults.

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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