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to seamlessly manage and monitor a managed care program and take it to the next level of value-based purchasing.” Going further, the report states “… our assessment found that some of the concerns and frustrations voiced by stakeholders are not due to the Georgia Families program design, but result from operational issues within the Medicaid program … DCH’s current leadership is working to communicate to stakeholders about efforts that are currently underway” to improve credentialing and eligibility, and revise contract language and reporting requirements. In other words, this could sound like managed care today and managed care tomorrow.
What Recommendations Does the Report Make? The report details four options the state may wish to pursue. Navigant recommend-
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ed that the state look at implementing Options 1, 2, or 3, leaving the most radical Option 4 on the table. Each of these recommended systems incorporates a managed care model. As the report states, “Through implementation and operation of Georgia Families over the past six years, DCH has built an infrastructure for operation of a managed care model.” Since the foundation is laid for this model, Navigant recommends moving along the same tracks with improvement of the basic model as a goal. Option 1: All patients, including those currently in the FFS payment system, would be enrolled in a managed care Georgia Families Plus, so essentially the same basic program as offered today with the additional groups of enrollees and presumably a renewed focus on streamlining and improving the system. Option 2: This option is Option 1 topped with what the report terms “commercial style managed care levers” applied to certain groups of patients. While certain pop-
ulations cannot be charged copayments or deductibles without a federal waiver, other tools such as HRAs and incentive payments or prizes could be brought into play. The goal is to have members stand to gain or lose from their health behavior decisions. Option 3: The only difference between Option 2 and Option 3 is that participating CMOs would be required to include Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs) in their provider networks. The goal of including ACOs and PCMHs would be to create a more patient-centered program that involves teams of providers sharing responsibility for care for individuals. Option 4: DCH would implement Georgia Families Plus for children, including children in foster care, and for individuals who are aged, blind and disabled as well as a “free market” health insurance purchasing program for low-income needy adults and potential expansion popula-