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Health care costs for poor draining Georgia budget

Tuesday, Feb. 21, 2012 7:21 AM
Last updated 8:05 PM
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ATLANTA — The Deal administration is trying to plug the big money drain in government: health care for the poor, especially the old and disabled.

The program is gobbling up more and more of the state budget, crowding out other state services. The possible savings are estimated in the hundreds of millions of dollars.

The elderly only make up 8 percent of the population covered by Medicaid, the program for the poor. Those 8 percent, though, generate 20 percent of the cost. The disabled are another 15 percent of all those covered, but they use 44 percent of the money.

On the other hand, the generally healthy children and adults constitute 72 percent of the population getting taxpayer-funded medical care but need only 36 percent of the expenditures.

Gov. Nathan Deal has lived with these numbers for years as ranking member of the Health Subcommittee in Congress before his election as governor. He assigned Community Health Commissioner David Cook to redesign the programs that provide health care to the poor as a way to rescue taxpayers while also improving the quality of care. Removing administrative headaches and safeguarding the livelihoods of doctors and hospitals were secondary goals.

“We constantly should be challenging ourselves to be the best government we can be,” Cook said.

What Cook may do has medical providers and advocacy groups nervous.

He started by hiring a national consulting firm to study Georgia’s Medicaid program and the PeachCare for Kids spinoff for children. It also reviewed what other states do.

It recommended that Georgia expand to the elderly and handicapped the same type of plan that the generally healthy people in the programs get. That plan is called care management, and it’s administered by three private, out-of-state companies called care-management organizations.

The CMOs are supposed to do more than handle claims paperwork. They are paid a flat fee for every person enrolled in their network, and the way the companies are supposed to earn their profit is by steering their patients to clinics and private physicians instead of expensive emergency rooms.

The consultant, Chicago-based Navigant Consulting Inc., argues that the elderly and handicapped would benefit even more from the intense interaction of care management because they’re sicker and need treatment more often. They might even avoid the need for some treatment if a CMO reminds them to take their medicine or get preventive checkups, they suppose.

“Nearly all studies demonstrated a savings from the managed-care setting,” the authors wrote. “… Savings from Medicaid managed care can be significant for traditionally high-cost enrollees.”

Redesign needed

In the five years since Georgia shifted to CMOs, taxpayers have enjoyed a slower rise in medical costs than the national average. The providers say that cost came out of their pockets because the CMOs simply didn’t pay them what they were owed.

“The only thing we have seen in the five years is they have been effective in cost management which they’ve done by cutting providers,” said Kevin Bloye, vice president of the Georgia Hospital Association.

The association estimates providers lost $1.1 billion since 2007.

It agrees a redesign is called for. It recommends one based on what North Carolina does by using physician-run, nonprofit administrators rather than CMOs. All of the doctors treating the same patient there share medical records.

Cook hasn’t rejected the suggestion, but he said it’s hard to compare North Carolina with Georgia because the states use different ways of keeping statistics.

“I would argue we are pushing quality up in Georgia,” he said.

The Medical Association of Georgia is formulating its own response to the consultant’s report within the next week. The Hospital Association’s board meets this week to determine its next move, too.

If the providers are concerned about expanding care management to the elderly and handicapped, the advocates for those groups are apprehensive as well.

“There are questions about how well managed care may work for populations with complex health needs, and the Department [of Community Health] should work with advocates for these vulnerable Georgians to ensure any redesign system does not disrupt or impede care for this fragile population,” said Cindy Zeldin, executive director of the advocacy Georgians for a Healthy Future.

She said the existing system could be improved for those already in managed care.

No decision yet

The elderly and handicapped weren’t included in managed care to begin with because vigorous advocacy highlighting the “vulnerable” and “fragile population” convinced policymakers at the time not to take on a protracted political battle with an organized group that is emotionally sympathetic to voters. Disability Day brought hundreds of handicapped individuals to rally on the Capitol steps Thursday in the chilly rain.

 On the other hand, the CMOs naturally argue in favor of it and its expansion.

 “By doing so, Georgia would simply be following national trends in managed care and acting in the best interest of the taxpayers who foot the bill,” said Derrick Dickey, spokesman for the three CMOs.

 The commissioner says he hasn’t made up his mind. His timetable calls for accepting public comments until the end of the month. His agency began last week working in task forces to sift through the comments and the consultant’s report for a conclusion. Transition would begin in 2014.

 His decision could have a major impact on taxpayers’ pocketbooks and the lives of thousands of poor people whose health will be governed by it.

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Riverman1
79543
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Riverman1 02/21/12 - 10:09 am
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Health care costs are

Health care costs are astronomical for the state budget. State retirees are going to be costing the state more than the entire current budget in about 10 years in medical care alone. The only way to fix that is to have state workers and retirees begin paying a bigger deductible NOW.

itsanotherday1
40304
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itsanotherday1 02/21/12 - 10:40 am
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A good first start would be

A good first start would be to have ALL recipients cough up a co-pay unless they are seen at a clinic. Way too many resources are consumed in emergency rooms for non-emergency issues.

db16
95
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db16 02/21/12 - 11:17 am
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Hey Riverman, do you know any

Hey Riverman, do you know any State Employees? Have you asked them what they are paying for their healthcare, dental, short term and long term disability? You would be in for a rude awakening. It is staggering, compared to other states, what Georgia State Employees (particularly educators) are paying. Food for thought...$45 Co-Pay's for PCP's, $150 E.R. visits and $55 Specialist Visits...And how about this one for irony, Urgent Care Co-Pay is $35...so it would be cheaper to go to Urgent Care than your PCP!! Prescription Drugs 20/50/90...The State of Georgia is Affordable by means of Taxes...but it is robbing its employees blind in all other facets!

Riverman1
79543
Points
Riverman1 02/21/12 - 11:35 am
0
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Yep, I've got a state

Yep, I've got a state employee in the immediate family. Look, I realize this is tough. It may be impossible. A few years ago there was a study that said the medical care costs of retired state employees would equal the entire current budget of the state in about 20 years. I may be a little off with my earlier 10 year remark, but it's obvious this is not going to work. The answer in the past is growth would take care of the shortfall, but there is no projection that shows that kind of growth. So I ask you, what can we do, but start making cuts now? We have to cut goverment benefits and the number of employees.

db16
95
Points
db16 02/21/12 - 12:15 pm
0
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I agree Riverman...that is a

I agree Riverman...that is a great point. You have to also consider the fact that there are also Golden Eggs sitting in the Golden Dome in Atlanta that have everything taken care of and don't contribute at all. As the Current Employees retire and the systems continue to absorb through attrition, there will be more pulling out than putting in...which is going to wreak havoc. And finally, everyone knows the drain on our system is not just a Georgia Problem...it has become a National Epidemic. The ones putting into the system suffer in the long run, while those who pull from the system (legally and illegally) will ultimately cause the collapse of this once prosperous nation.

Craig Spinks
817
Points
Craig Spinks 02/22/12 - 04:35 am
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We got to move from a

We got to move from a fee-for-free-service model that reinforces physicians', surgeons' and other medical service providers' doing more to make more; patient hypochondria; and the "here-I-am, fix-me" attitude of the ignorant and irresponsible. Instead of the 3FS-model, we've got to establish, maintain and continually improve a seemless health maintenance one with incentives for doing things which contribute to health and with punishments(disincentives for the squeamish) for doing things that undermine one's physical well-being.

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