State discusses ideas on new Medicaid design

Print Friendly and PDF By: Andy Miller Published: Jan 26, 2012

The head of Georgia’s Medicaid agency said Thursday that despite criticism of the program’s current model of care, doctors and other medical providers agree with the idea of ‘‘well-managed care’’ for patients.

The state currently operates a managed care system for most Medicaid and all PeachCare members. A report from consulting firm Navigant, released last Friday, called for Georgia to consider adopting an enhanced managed care system that would cover new segments of Medicaid patients.

David Cook, commissioner of the Department of Community Health, told reporters in a media briefing that while people often have a negative impression of managed care, they generally agree with its principles of coordinating a patient’s treatment.

The Georgia Hospital Association recently criticized the state’s current HMO-like set-up. It called instead for a Medicaid system similar to North Carolina’s ‘‘patient home’’ model, which is run by physicians, not insurers.

The North Carolina Medicaid system “is not off the table,’’ Cook said to reporters. “It’s a great model to look at.’’

He added, though, that the way North Carolina measures quality of medical care is difficult to compare directly to Georgia’s. And the Tar Heel State’s cost savings must be evaluated as well, he said.

Community Health hopes to settle on a redesign model for the Georgia program in April, and then start a contract procurement process in the summer. The changes would be launched in January 2014.

Potential bidders could include the care management organizations (CMOs) handling the current program, as well as other major health insurers such as UnitedHealthcare and Blue Cross and Blue Shield of Georgia.

Georgia’s Medicaid and PeachCare programs cover about 1.7 million Georgians and have a budget that exceeds $7 billion, most of it federal money.

Expanding the eligible population

The Navigant report also recommended putting the ‘‘aged, blind and disabled’’ populations in managed care as well. The state’s Medicaid patients with disabilities or in long term care are currently in traditional payment systems.

Those patients are more medically complex, with greater health needs, Cook acknowledged. But he also noted that the state has had success moving many of them from institutions into more integrated community settings.

Community Health has challenged medical providers to give input about the Navigant report, Cook said.

While not specifically criticizing the current CMO set-up, Cook pointed out that the Medicaid program faces several challenges, including a rising population, the continuing economic slump, and a possible big expansion under the federal health care reform law.

“Medicaid is a hugely important safety-net program,’’ he said. The state has an obligation to improve quality care – while dealing within fiscal constraints – to “design a plan to meet those challenges that are coming down the road,’’ he said.

Cook said the Georgia Hospital Association report on the CMOs ‘‘made some good points.’’ But he added, “Some of the points they make are not accurate.’’

“Georgia is in a better place than a lot of states,’’ he said.

Cook said Community Health is discussing these issues with the hospital organization.

The agency is also asking physicians for their ideas, he said. An ample supply of doctors is crucial for the Medicaid program, and recently some doctors have stopped seeing new members.

“The physician community is looking at administrative simplicity,’’ so a primary goal is to ease the burden of red tape, Cook said.

The agency is also briefing legislators on the Navigant report, he said.

Enjoy Georgia Health News? Sign up for free Email Alerts or follow us on Facebook or Twitter

Help support our nonprofit journalism -- your gift is tax deductible!

Sponsorships



University of Georgia College of Public Health Logo





















(Click on the logo for more information about our sponsors.)





Foundation Support for GHN:

Healthcare Georgia Foundation
Kaiser Permanente
Reynolds Charitable Fund
Georgia Health Foundation