Best Practices in Medicaid - Georgia
The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.
View Georgia's Official Medicaid website >>
Delivering high quality, coordinated, long term care for the disabled and/or the infirm
Georgia Enhanced Care–Disease Management Programs
- Provided by APS & United Healthcare/AmeriChoice
- 100,000 members in the Aged, Blind & Disabled Programs
- Began in October, 2005
- Chronic illnesses addressed:
- Diabetes
- Congestive Heart Failure
- Coronary Artery Disease
- Asthma
- Hemophilia
- Schizophrenia
Nursing Home Quality Initiative
· Collaboration: Department of Community Health & Nursing Homes
· Monitor Quality of Care Indicators
· All Georgia nursing homes participate
· Each conducts self-improvement assessments
SOURCE: Service Options Utilizing Resources in Community Environments
· Partnership with several healthcare organizations in the program
· Provide enhanced case management to a targeted group of Medicaid recipients who suffer from chronic illnesses.
· SOURCE provides primary physician care and intensive case management of chronically ill and frail Georgians in order to avoid preventable hospital and nursing home admissions.
· Established in 1997, SOURCE was developed by St. Joseph’s/Candler and was launched as a Medicaid demonstration project in Savannah, Baxley, Atlanta and Augusta.
· SOURCE combines primary medical care with support services which is coordinated through trained case managers working directly with primary care physicians
Use of health information technology (electronic health records, e-prescribing, electronic billing, etc)
October 2006: Governor Sonny Perdue issued an executive order creating the Health Information Technology and Transparency (HITT) Advisory Board.
November 2006: Commissioner Medows announces HITT Advisory Board members.
October 2007: CMS awarded DCH a $3,929,855 Medicaid Transformation Grant to assist with the implementation of Georgia’s transparency Web site for health care consumers.
November 2007: DCH issued $853,088 in HIE grants to four organizations that will help foster the development of HIE, electronic prescribing, and/or adoption of electronic medical records across Georgia.
December 2007: DCH submitted a proposal to participate in the Health Information Security and Privacy Collaboration with seven other states.
January 2008: DCH announced creation of the Office of HITT.
April 2008: DCH to announce Transparency Web site vendor contract.
April 2008: Georgia begins work on the HISPC Collaboration
Transparent and publicly-accessible measurements of patient outcomes and/or quality improvements
In Georgia Healthy Families, our Medicaid Managed Care Plans are developing a Quality Improvement program will incorporate at the beginning specific performance and outcome measures that will focus on health disparities in addition the general clinical performance measures most plans do. We recognize that greater than 50 of our Medicaid population and approximately 25% of our SCHIP population are ethnic/cultural minorities. We also recognize that effective delivery of health care can not be fully achieved until the barriers contributing to the disparities are identified and resolved. Specific areas of disparities under consideration: low birth weight, asthma, diabetes, breast cancer mortality rates, etc.
What are your future plans?
- Health Information Technology Development
- Administrative Services
- Organizations for the Aged, Blind & Disabled Programs including:
- Eligibility Quality Assurance
- Eligibility: Data Broker
- Medicaid Program Integrity
- Level of Care
- Clinical Programs (Care & Disease Management)
- Long Term Care Partnership & Planning