Ga. explores private management of Medicaid

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ATLANTA — Georgia officials are exploring whether the state could expand its use of for-profit companies to hold down ballooning Medicaid costs and better coordinate care, The Atlanta Journal-Constitution reported Sunday.

The program, which costs about $21 million daily, provides care for the needy, aged, blind and disabled and low-income families with children. Some 1.7 million residents are enrolled.

“The current Medicaid program design cannot be sustained,” David Cook, the commissioner of the Georgia Department of Community Health, told the newspaper. He expects an annual Medicaid deficit of more than $600 million within three years. “By acting now, we can save this important safety net program while improving quality care and providing greater value for patients and the public.”

In January, a consultant’s report recommended using private companies to manage Medicaid. Since then, state authorities have convened task forces of health care providers and others to explore the options. Those choices range from maintaining the current system to letting hospitals and doctors manage care. Now state health officials are preparing to make decisions.

Gov. Nathan Deal, a Republican, said the department has taken the right approach by analyzing its options. Lawmakers would not need to approve the proposed changes.

“Unsustainable costs are the driving forces behind the state’s Medicaid redesign,” said Deal spokesman Brian Robinson, “but beyond that, Gov. Deal wants reforms that will focus on higher-quality outcomes for recipients.”

Medicaid officials said three companies already coordinating Medicaid treatment largely for poor children have saved the state more than $400 million between 2007 and 2011. Peach State Health Plan, for example, said it has reduced the number of preterm births and made it less likely that children in its program will need to visit a hospital for asthma treatment.

But a state-ordered report found that Georgia’s management companies performed at or below the 50th percentile for 40 of 47 measures of quality analyzed in 2009 compared to other managed care programs.

Medical providers have questioned whether for-profit companies can improve care, spend less than the current system and earn a profit in a program that caregivers say fails to pay them enough for treating Medicaid patients.

The president of the Medical Association of Georgia, Dr. Sandra Reed of Thomasville, said about half of her practice deals with people using Medicaid. Physicians in fields dominated by Medicaid patients have said the program’s low payments and red tape force them to spend more time focusing on claims and less time on patients. If the state increasingly uses for-profit companies to manage care, doctors said it could put more financial pressure on them.

Reed, for example, said she has added cosmetic services to her practice.

“We just can’t keep our doors open if all we do is run our practice on what we make from practicing medicine,” she said.

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Sweet son
Sweet son 06/03/12 - 07:11 pm
All Government is Fat from Top to Bottom!!

We all know that we have too many government employees who might not make so much in salaries but when you add the benefits on the top they all are very expensive. Let the private companies give it a try with a small watchdog group to look over their handling of the job. In most cases it has been proven that private for profit companies watch their pennies more than any government agency ever has. Allow the State employees who have enough time to retire to do so. Offer the others their jobs back but with a reduction in the force and close supervision by the private company of the day to day activities. Sounds hard but things are tough all over!

birdieman 06/03/12 - 09:22 pm
These 3rd party companies got to get paid.

The companies mentioned above, Wellcare, Peachstate and Amerigroup are for profit companies. These companies are going to make sure they get paid first before they pay MDs, hospitals, DME, etc. IE: reduce what they pay for goods/services or not cover them at all.

Here's an idea for saving GA medicaid some money:

Look at all of the people that are on medicaid. It needs to be like unemployment. Someone who receives medicaid needs to make an effort to try and get off of it. Maybe also have a capped number of months that you can receive it before your cut off.

OhWell 06/04/12 - 05:40 am
I do billing and practice

I do billing and practice management in KY and the for profits do work. Patients have to have prior authorization for needed test that traditioal Medicaid will pay for no matter what. I have seen Medicaid pay for 8 sonagrams on a patient that had no high risk factors to warrent this. For profit programs closley monitor wellnes programs and as a whole are much more effective and the 31 providers we support have seen no loss of revenue. I am familar with WellCare and Amerigroup but have no affiation with Peach Care.

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