An Interview with Georgia DCH Commissioner David A. Cook on Managed Care Featured in MAD Spring 2012

Medicaid Redesign: Charting Improvements in Medicaid and PeachCare for Kids®
An interview with Georgia Department of Community Health (DCH) Commissioner David A. Cook.

The goals of a multi-year redesign initiative undertaken by the Georgia Department of Community Health (DCH) are to bring improvements to healthcare outcomes for members, enhance appropriate use of services by members and long-term financial sustainability. As the nation prepares to implement the Affordable Care Act, DCH Commissioner David A. Cook answered the following questions about the redesign of its Medicaid and Children's Health Insurance Program (CHIP/PeachCare for Kids).

Why did DCH see a need to move to managed care?

In 2006, state leaders took action to address what was considered "unsustainable growth" in the Medicaid program in which 60% of all new state revenue would be consumed by growth in the program. DCH moved to a managed care model for the majority of its Medicaid populations as a way to address utilization that accounted for more than one third of total growth year over year.

Our focus is to improve access to quality care while maintaining a Medicaid program that is fiscally responsible and sustainable, particularly in light of the dramatic expansion of eligibility called for under the Affordable Care Act.

What were the goals of the redesign initiative and how did they ensure continuity throughout the process?

Early in the process, DCH identified three weighted goals and six weighted strategies to be used to evaluate the research and recommendations. These are:

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These goals and strategies will be used throughout the evaluation phase of the redesign to guide our decision making about the best healthcare delivery model for Medicaid and CHIP program members and their families.

Here's some background about the redesign initiative:

In February 2011, the Department released a Request for Proposals (RFP) for a consulting firm to manage this process. Navigant Consulting Inc. was awarded the contract in the summer of 2011.

Navigant began the assessment phase in August 2011 with:

• 30 statewide focus groups that included providers, physicians, Medicaid members and caregivers, advocacy groups, legislators and others
• More than 400 online surveys completed by a wide range of stakeholders using categoryspecific questionnaires
• A national environmental scan of various states' Medicaid programs – DCH requested that Navigant examine 12 states
• A Georgia environmental scan to determine what is working and what can be improved in Georgia's existing system

In January 2012, Navigant presented its Redesign Strategy Report, a 400-page document that outlined the results of the research and presented nine recommended options for delivery systems, ranging from full risk-based managed care to free market health insurance. Since the release of the report, DCH has welcomed feedback through an online feedback tool, special email box, detailed written comments and both large and small meetings. Additionally, task forces representing three groups – the Aged, Blind, Disabled (ABD); Providers and Children and Family populations – are underway. These groups serve as advisers to DCH in building out certain aspects of the design plan and implementation.

What role has the Governor's office played?

Governor Deal asked DCH to review the current Medicaid and CHIP programs in Georgia when he first came into office in January 2011. The Governor's office has been involved throughout the process, which began in February of last year.

Perspective of the Navigant report?

The report was well done and includes extensive research and information as outlined. Additionally, the report includes a variety of possible plan models – from full risk-based coverage to commercial style, free-market, fee-for-service plans. (See www.dch.georgia.gov to read the executive summaries and the entire report.)

In addition to an evaluation of the nine general option models, Navigant narrowed those options to four to consider specifically for Georgia's implementation, again measuring those options against the three weighted goals and six strategies listed in the chart.

Currently, DCH is analyzing and reviewing the report, meeting with scores of stakeholders and advocacy groups to garner their feedback and comments and weighing the feasibility of the best plan models.

What else is DCH doing to get input?

DCH created a feedback tool through its website. It was available for the first six weeks(mid-January to the end of February) after the report was released. Comments are still being accepted through ,which is monitored regularly by staff.

Additionally, DCH has created the three task forces – Aged, Blind and Disabled; Providers; and Children and Families. These groups are meeting regularly to discuss the details of the various plan options presented in the report and to provide input to the agency.

Who (groups, people) will be deciding on the best course of action?

The Department will make a decision on the path forward after consultation with the Governor and appropriate stakeholders.

When will that happen?

Timing for introducing the new plan models is early 2014. Several factors are in play: the implementation of the Affordable Care Act, the end of current contracts with our three Care Management Organizations (CMOs), who are providing services at this time and the results of review and evaluation of the possible delivery strategies.

We are currently in the Recommendation Phase, with many decisions to be made before DCH moves forward to the Procurement Phase. We anticipate that the Request(s) for Proposals will be issued during the last half of 2012.

Are there programs from other states that you will be taking pieces from?

All options are on the table. We are indeed looking at programs from other states, but beyond that, we cannot speculate about what our program will look like.

What does DCH see happening (with regards to a health and social aspect) to the final product?

It's too early in the process to speculate about the final outcome. Right now, we are examining all options, weighing them against our three goals and six strategies.

We continue to welcome comments through and we encourage people to visit our website to read the executive summary and the report at www.dch.georgia.gov.