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Welfare Watch -
January 25, 2012 - DCH Releases
Medicaid and CHIP Redesign Strategy Report
Recognizing that Georgia's health care
costs are more than $2.3 billion and 21% of the state's budget, it
is no wonder that the State is looking at options to lower the costs
while providing quality services. The Department of Community
Health contracted with Navigant to do a redesign study of the
Medicaid and PeachcCare for Kids programs and offer suggestions for
its redesign.
Its purposes were to offer an assessment
of what is working in Georgia and how it could be better. This
would done through survey, reviews of national programs and an
emphasis on a "value-based" program that could better serve those
who participate in the programs. These suggestions were made
with an eye on how to save money while improving health care.
This was a tall order for any study or department that serves the
critical needs of so many vulnerable citizens in Georgia.
DCH's budget has essentially stayed the same since 2009 yet it
serves more than 100,000 Georgians than it did in 2009.
The observations and recommendations of
the report take an evolutionary approach. Georgia needs to
move beyond the "process-based" method of purchasing of health care
services to a more "value-based" method of purchasing services
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this includes:
• Increasing
communication among all stakeholders
• Reducing administrative complexities and burdens for providers
and members
• Standardizing, centralizing or streamlining appropriate
processes and forms across the CMOs
• Increasing patient compliance through incentives and
disincentives
• Increasing focus on health and wellness programs and
preventive medicine
Rather than using Care
Management Organizational (CMO) model to manage care, the Department
should consider the use of Accountable Care Organizational (ACO)
model. ACOs would function much the same way as CMOs but
would focus more on outcomes and value to the consumers.
Navigant recommendations
centered around the Georgia Families' model with expanded
permutations. It is value-based
purchasing, encourages implementation of medical homes, minimizes
administrative complexities and burdens for providers and members,
increases patient compliance through incentives and disincentives,
increasing focus on health and wellness programs and preventive
medicine and builds upon current efforts to focus on quality.
All options presented
"carved-in" covered populations rather than "carved-out"
populations. Foster children, behavioral health, the aged,
blind, and low income were included in an ACO model.
The report did not
minimize the difficulty of implementing a new model. It was
presented as a first step in achieving the quality health care that
we want for all citizens of Georgia.
The
full report and
summary can be found on the
DCH website with other supporting information.
Press Release From DCH - ATLANTA (January 20, 2012) – The Georgia Department of Community Health (DCH) released its Medicaid and CHIP (Children’s Health Insurance Program) Redesign Strategy Report on January 20th. It is posted on the DCH website at www.dch.georgia.gov/medicaidredesign .
“In these challenging economic times, one of our statewide priorities is to continue to provide access to cost-effective, quality health care for all our citizens -- including those treated through our Medicaid safety-net providers,” said Gov. Nathan Deal. “DCH’s Medicaid Redesign Initiative 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 is the result of months of research, fact finding and information gathering from consumers, physicians, hospitals, advocates, legislators and other stakeholders, as well as numerous reviews of Medicaid programs in other states.
In the first phase of the Medicaid and CHIP Redesign, which took place from September to December 2011, Navigant Consulting conducted both national and Georgia-specific environmental scans, managed 30 statewide focus groups and reviewed more than 400 online surveys from stakeholders.
“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 re-building what can be working better for those we serve,” said DCH Commissioner David A. Cook. “During this evaluation process, 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.”
The Strategy Report includes information that will allow Georgia officials to:
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Assess what is currently working and what could be working better here in Georgia;
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Discover the innovation in what others around the nation are doing and how that innovation can be used or even improved upon here in Georgia;
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Create and implement value-based program, financial and service delivery models that will better serve members, providers and Georgia’s taxpayers; and
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Monitor and improve on these models on a continuing basis.
“As we move into this part of the Recommendation phase, we will evaluate the report against our previously adopted weighted goals and strategies,” Cook said. “Our major goals are to enhance appropriate use of services by members, achieve long-term sustainable savings in services, and improve health care outcomes for members.”
The public and interested stakeholders can view the report at
www.dch.georgia.gov/medicaidredesign Feedback about the report is welcomed, in two preferred ways: detailed comments entered through an online feedback tool at the DCH website
www.dch.goergia.gov/medicaidredesign or brief comments sent via e-mail to
MyOpinion@dch.ga.gov .
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An email newsletter of the
Georgia
Association of Homes
and Services for Children
as a public service.
Normer Adams, Editor
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