Key report on Medicaid calls for big change

A consulting firm’s long-awaited report calls for Georgia to consider adopting an enhanced managed care system for its Medicaid and PeachCare populations.

The Navigant report was commissioned by the state, and it was released Friday by state officials. Hundreds of pages in length, it analyzes Medicaid set-ups in several states and points to weaknesses in Georgia’s overall health care system.

It also evaluates the state’s current Medicaid and PeachCare programs, which cover about 1.7 million Georgians and have a budget that exceeds $7 billion, most of it federal money.

Gov. Nathan Deal, in a statement, said the state’s Medicaid ‘‘redesign’’ initiative, led by Georgia’s Department of Community Health, “will allow the state to examine new and innovative program delivery models so that we can develop value-based solutions to help us achieve program and financial sustainability.”

The report comes at a time of extraordinary transformation in the health care field, and as Navigant noted, that transformation goes far beyond Medicaid.

“The current health care environment is undergoing a period of rapid change as the federal government, states, health plans and consumers deal with the implications of health care reform in an era of budget deficits, high unemployment and grim forecasts for short‐term economic growth,’’ the report said.

Several states are pursuing major changes in their Medicaid programs, with most injecting more managed care into the services they provide for low-income and disabled residents.
The study follows reports by the Georgia Hospital Association and two consumer groups that recommended big changes in Georgia’s ‘‘care management organization’’ (CMO) program. The state currently contracts with three CMOs to run PeachCare and a large share of its Medicaid program.

The Navigant study cites Georgia’s three goals for its Medicaid population –- to enhance appropriate use of medical services by members; to achieve long-term savings; and to improve health outcomes for patients.

And the report recommends that the state look at three options that would be most likely to achieve those goals.

The first would be to revamp the current HMO-like structure to feature a system that would pay medical providers based on the health outcomes of patients.

This option would encourage the use of patient-centered medical homes, include incentives to increase patient compliance, and emphasize wellness programs and preventive medicine.

And in what would be a striking change, this managed care program would cover some populations not currently served by the CMOs, including those in long-term care and disability programs.

The second option would incorporate that enhanced HMO-like model, but also would move many Medicaid recipients into private insurance plans that would encourage healthy behaviors by their members.

The third option would include the above features while also offering the option of contracting with patient-centered medical homes and organizations run jointly by doctors and hospitals.

The report notes that Georgia’s health care system has several well-known problems, including a severe shortage of primary care physicians, especially in rural areas; a relatively weak quality of care; and high rates of infant mortality and uninsured people.

Though Georgia has low Medicaid spending per beneficiary, the Navigant report cites one big area for cost savings — the population in nursing homes and in disability programs. Nationally, these ‘‘aged, blind and disabled’’ populations account for 23 percent of the Medicaid population, but account for nearly 64 percent of the expenditures.

Navigant held many meetings with focus groups and stakeholders, including physicians, hospitals, legislators, and consumer advocates. These groups gave several recommendations, including better enrollment procedures and communication with members.

Health industry groups and consumer advocates were still poring over the lengthy, detailed report Friday, and their initial responses to it were cautious.

The Medical Association of Georgia, a large physician organization, issued a statement saying, in part, that it ‘‘looks forward to continue working with the Georgia Department of Community Health to design a Medicaid program that is viable and sustainable –- which isn’t the case today.’’

Cindy Zeldin of the consumer group Georgians for a Healthy Future said that if Community Health moves forward with Navigant’s recommendations, “it is our hope that best practices for getting and keeping kids enrolled and connecting them to appropriate services are incorporated into the design selection.”

What’s next in the redesign process?

“Now that the report has been delivered, we will begin our review and analysis to assimilate the information . . . building on what is currently working and rebuilding what can be working better for those we serve,” said David Cook, commissioner of Community Health, in a statement.

“During this evaluation process,” Cook continued, “we will identify opportunities to eliminate unnecessary and costly bureaucratic red tape, ease administrative burdens, enhance efficiencies and improve access and health care outcomes in a fiscally responsible way.”

Here’s a link that will take you to the Navigant report.