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Medicaid and CHIP Redesign. Presentation to: HomeTown Health Presented by: Jerry Dubberly, Chief Medicaid Division April 27, 2012. Mission The Georgia Department of Community Health

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Medicaid and CHIP Redesign

Presentation to: HomeTown Health

Presented by: Jerry Dubberly, Chief Medicaid Division

April 27, 2012


The Georgia Department of Community Health

We will provide access to affordable, quality health care to Georgians through effective planning, purchasing and oversight.

We are dedicated to a healthy Georgia.


navigant consulting inc
Navigant Consulting, Inc.
  • DCH contracted through RFP with Navigant Consulting, Inc. to conduct Medicaid Redesign Strategy Evaluation.
  • Navigant will assist through all phases of review (initial analysis through final implementation)
  • Navigant is a global business consulting firm with experience in healthcare, construction, energy, financial services and government services.
  • Navigant’s Healthcare practice focuses on Payer Strategy, Provider and Life Sciences
    • Navigant has worked with virtually every state Medicaid program
      • Relevant experience in:
        • Commonwealth of Pennsylvania
        • State of Indiana
        • State of Mississippi
        • BCBS Federal Employee Program (FEHBP)
strategy report
Strategy Report
  • National Environmental Scan
    • Targeted Select States for In-Depth Review:
  • Georgia-Specific Environmental Scan
  • Options and Evaluation
timeline reassessment
Timeline Reassessment
  • DCH is reassessing its timeline now
  • Factors include:
    • Stakeholders’ desire to extend analysis phase
    • Speed of Task Force work that is ongoing
    • Speed of financial projection and actuarial analysis
    • Imminent ruling on ACA by the U.S. Supreme Court
    • Further evaluation of stakeholder proposals submitted to the Department
task force update
Task Force Update
  • Task Forces Established
    • Provider
    • Aged, Blind and Disabled
    • Children and Families
  • Workgroup Underway
    • Substance Abuse and Mental Health
task force update1
Task Force Update
  • Logistics
    • Eight (8) meetings to date
    • Each meeting 3 to 4 hours
  • Role
    • Advisory in nature
    • Input and feedback
    • Constituted throughout the project
task force update2
Task Force Update
  • Common Themes
    • Improve access and develop strong primary care infrastructure
    • Achieve administrative simplification
    • Promote consistency across all Care Management Organizations (CMO) vendors
    • Develop uniform and portable procedures for pre-certification/prior authorization
task force update3
Task Force Update
  • Common Themes
    • Use a person-centered model encouraging achievement of NCQA Patient-Centered Medical Home status
    • Allow provider-driven access to case management and coordination
    • Ensure continuity of care and access to services
    • Provide a true focus on quality and outcomes
    • Require an “any willing provider” clause in contracts
    • Prohibit all product clauses from CMO vendors
task force update4
Task Force Update
  • Common Themes
    • Maximize the use of technology to disseminate information to providers
    • Maximize federal funding streams (UPL, BIP, etc.)
    • Re-evaluate provider reimbursement methodologies
    • Ensure vendor accountability
    • Make sure DCH and sister agencies work together
    • Ensure proper oversight
task force update5
Task Force Update
  • Common Themes
    • Integration of Physical and Behavioral Health
    • Take a more holistic view of the individual’s needs
    • Develop true “systems of care” approach
      • Peer support
      • Recovery model
    • Develop better substance abuse and mental health solutions
    • Expand access and offerings available through the Home- and Community-Based Waivers
task force update6
Task Force Update
  • Common Themes
    • Recognize unique needs of various populations served
    • Identify mechanisms to improve coordination of care for dual-eligibles between Medicare and Medicaid
    • Include foster care in a managed care model
    • Focus on wellness with incentives for members demonstrating healthy behaviors
task force update7
Task Force Update
  • Common Themes
    • Continue stakeholder input and communication
    • Implement new delivery model in phases
    • Follow a reasonable, realistic and appropriate timeline to allow for success