Consumer groups urge Medicaid revamp

Another report recommending big changes in Georgia Medicaid and PeachCare has been released, ahead of the state’s own analysis of the two health insurance programs.

The new report, from the consumer advocacy groups Voices for Georgia’s Children and Georgians for a Healthy Future, calls for more streamlined enrollment, stronger accountability measures, improved access to specialty physicians, and a more coordinated, patient-centered system of care.

The state of Georgia has commissioned a study by the consulting firm Navigant of a possible redesign of Medicaid and PeachCare, and that study’s results are expected to be released this week.

The consumer groups’ analysis, written by Rebecca Kellenberg of Kellenberg Consulting, is likely to intensify the burgeoning debate about the future of the two programs. The administration of Gov. Nathan Deal will face a big decision on whether the state should preserve the current HMO-like structure, make changes to it or start over with a new design.

“Our report highlights the opportunities we have as a state to ensure coverage, access and quality health care to all of Georgia’s children, despite these tough economic times,’’ said Voices for Georgia’s Children and Georgians for a Healthy Future in a statement Tuesday.

“Borrowing from successes in other Southern states like Alabama and Louisiana, we believe that there are tried and true ways to make Medicaid and PeachCare work better for our state’s children, and we look forward to bringing those opportunities to light through release of this report and [the state’s] redesign process,’’ the statement said.

Amerigroup, one of the three companies running ‘‘care management organizations’’ (CMOs) for Georgia Medicaid and PeachCare, declined to comment on the new report Tuesday. Officials with Centene and WellCare, the other two companies, could not immediately be reached for comment.

The state Department of Community Health, which runs Medicaid and PeachCare in Georgia, declined to comment on the new report.

Last month, the Georgia Hospital Association issued its own report on the issue, and it took an even stronger tone than the consumer groups’ analysis. It urged the state to scrap its current CMO structure for Medicaid and PeachCare, which cover more than 1 million lower-income residents, most of them children.

GHA, in a letter to state officials and Navigant, said the ‘‘minimal savings’’ that the managed care program has achieved have come at the expense of medical providers. The hospital association recommended the Medicaid model adopted by North Carolina, a public-private “medical home’’ partnership run largely by physicians.

(Here’s GHN’s article from last week on the hospital association’s position.)

The report from Voices for Georgia’s Children and Georgians for a Healthy Future calls for a medical home system of care for children and other beneficiaries, one that ‘‘holds providers accountable for quality and ensures access to coordinated care.’’ But the report does not call for Georgia to follow a particular state’s blueprint.

A medical home model could work like North Carolina’s structure or in a managed care arrangement like Oregon’s, the report said.

Medicaid is the program for low-income and disabled residents, while PeachCare covers uninsured children in lower middle-class and middle-class households. Each program is jointly financed by the federal government and the state.

Georgia has succeeded in reducing its rate of uninsured children from 11 percent in 2008 to 9.8 percent in 2010, the report noted. Still, most uninsured Georgia children are eligible for but are not enrolled in Medicaid or PeachCare.

While the state has improved enrollment procedures, more needs to be done to simplify this process, said the report, citing programs in Alabama, Louisiana and Utah.

Among the other findings of the consumer groups’ report:

• The current CMOs do not meet state requirements on providing access to pediatric specialists in endocrinology, infectious disease and rheumatology. The southwest region of the state appears to have the worst access for children to specialists.

• The CMOs fail to meet performance targets for well-child visits, and early child screening rates are below the national average.

• Fewer than half of Georgia’s children with behavioral health care needs obtain the services they need.

“Georgia is not alone,” the report said, adding that “many states must better manage the care of children with complex behavioral health conditions.’’

The report pointed to two programs elsewhere that should be models: Texas’ electronic health records (EHR) system and Rhode Island’s use of specially trained parent consultants called Family Resource Specialists.

“Georgia has the potential to establish a similar statewide EHR for Medicaid and PeachCare enrollees by building on current efforts under way,’’ the report said.