0Georgia Department

of Community Health

Presentation to: 2013 Joint Study Committee on Medicaid Reform

Presented by: Jerry Dubberly, Chief Medical Assistance Plans

Date: October 28, 2013

Georgia Department

of Community Health

ABD Care Coordination Program

1Georgia Department

of Community Health

MissionThe Georgia Department of Community Health

We will provide Georgians with access to affordable, quality health care through

effective planning, purchasing and oversight.

We are dedicated to A Healthy Georgia.

Georgia Department

of Community Health

2Georgia Department

of Community Health

ABD: 29% Medicaid Enrollment –

58% Medicaid Expenditures

0%

10%

20%

30%

40%

50%

60%

70%

80%

% of Medicaid Enrollment % of Medicaid Expenses

29%

58%

71%

42%

ABD LIM

3Georgia Department

of Community Health

ABD Population – Medicare Eligibility

0%

20%

40%

60%

80%

100%

NonManagedABD

CCSP COMP KB GAPP HomeHealth

Hospice SOURCE ICWP NOW NursingFacility

NonDual

Dual

4Georgia Department

of Community Health

ABD Population Costs (PMPM)

$340

$1,298

$4,649

$757

$9,024

$3,671

$4,141

$1,690

$3,904

$1,187

$3,358

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000

All Others

CCSP

COMP

KB

GAPP

Home Health

Hospice

SOURCE

ICWP

NOW

Nursing Facility

PMPM

5Georgia Department

of Community Health

ABD Emergency Room Rates Per 1000 Members

*Total cost represents both waiver and non waiver FFS expense

1,055

1,489

756

307

2,796

4,165

2,036 2,048

1,452

368

1,207

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

ABD NonManaged

CCSP COMP KB GAPP HomeHealth

Hospice SOURCE ICWP NOW NF

6Georgia Department

of Community Health

ABD Inpatient Admission Utilization

216.27

506.84

149.53

91.01

1,358.04

2,034.09

1,167.58

443.86

532.56

67.09

555.08

-

500.00

1,000.00

1,500.00

2,000.00

2,500.00

$-

$5,000.00

$10,000.00

$15,000.00

$20,000.00

$25,000.00

$30,000.00

ABD NonManaged

CCSP COMP KB GAPP HomeHealth

Hospice ICWP NF NOW SOURCE

Net Pay / Admit Admits / 1000

7Georgia Department

of Community Health

ABD Readmissions and Avoidable Admission Rates

12%12%

8%

2%

1%

7%

13%

20%

23%

27%

0%

5%

10%

15%

20%

25%

30%

0 to 19 Years 20 to 44 Years 45 to 64 Years 65 to 84 Year 85+ Years

ReadmissionRate

AvoidableAdmissionRate

8Georgia Department

of Community Health

Title or Chapter Slide

(use as needed; feel free to delete) Aged, Blind and Disabled Care

Coordination Program

9Georgia Department

of Community Health

ABD Care Coordination Model

What we heard from stakeholders:

• Segments of ABD population would significantly benefit from

intensive care management

• Use navigators to help members obtain timely needed services

• Use a person-centered model with a holistic view of an

individual’s needs

• Improve care coordination for Medicaid/Medicare dual eligibles

• Contractor monitoring and oversight must be DCH priority

10Georgia Department

of Community Health

ABD Care Coordination Program

• Care Coordination model for all ABD populations• Voluntary – all members will have the ability to opt-out• Features:

– Single statewide vendor– Fee-for-Service environment– Care coordination, case management, disease management– Patient Centered Medical Home– Primary Care Case Management Model– Provider Engagement– Value Based Purchasing

11Georgia Department

of Community Health

ABD Care Coordination Program

• All members will have access to:

– Member Care Coordination Call Center

– 24/7 Nurse Call line

– Outreach and Education relevant to patient’s healthcare and disease state(s)

• Providers will be able to refer issues and opportunities for better coordination to Vendor for follow up and intervention.

12Georgia Department

of Community Health

ABD Care Coordination Program

• Certain members will have access to Intensive Medical Coordination Services

– High risk, high utilizing, highly impactable members

• Intensive Medical Coordination Service

– Engage members and conduct health risk assessments

– Form treatment plans utilizing interdisciplinary treatment teams

– Connect members with medical homes by developing, engaging, and incentivizing a provider network

– Improve coordination of care

13Georgia Department

of Community Health

ABD Care Coordination Program

• Desired results:

– Improve patient outcomes

– Connect members with necessary and appropriate care

– Reduce unnecessary utilization

– Fiscal improvement

14Georgia Department

of Community Health

ABD Care Coordination Program

• Vendor will not:

– Establish Medicaid policy

– Pay claims for Medicaid services

– Set reimbursement rates

– Authorize or deny Medicaid services

– Supplant or replace existing care coordination services

15Georgia Department

of Community Health

ABD Care Coordination Program Timeline

Date Event

November 15, 2013 RFP Release

February 10, 2014 Notice of Award

May 7, 2014 Contract Executed

May 7, 2014 through September 31, 2014 Implementation Phase

September 1, 2014 “Go/No Go” Decision

October 1, 2014 Go Live

16Georgia Department

of Community Health

Title or Chapter Slide

(use as needed; feel free to delete) Questions

17Georgia Department

of Community Health

Data Reference

-Total expense and utilization measures in this analysis represent FY2011 incurred data with claims paid through July 2012

-Total expense represents state and federal dollars

-Pharmacy rebates are not accounted for in total expense

-Unless otherwise noted, expense represents net payments for fee for service claims

-This analysis includes members with Medicare coverage