DCH-i [Vol. 1, no. 2 (Nov. 2011)]

Georgia Department of Community Health

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Home DCH-i November 2011, Vol. 1 Issue 2
DCH-i November 2011, Vol. 1 Issue 2

DCH-i November 2011, Vol. 1 Issue 2

About DCH-i
DCH-i is the monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important information to you as physicians, dentists, hospitals, third-party payers, vendors, health care advocates, consumers and legislators. Our goal is to help create A Healthy Georgia together. Write us at DCH-i@dch.ga.gov.
In This Issue
From the Commissioner Ask DCH-i Around DCH Medicaid Update Georgia Medicaid Recognized 5010 - Are You Ready? Medicaid Telemedicine Summit National Rural Health Day Speaking Up! - Commissioner's Speeches Welcome Blake Fulenwider, New DCH Deputy Commissioner
Do You Want to Be Heard? Do you have a question or a comment? A special request, perhaps? Tell us what's on your mind at DCH-i@dch.ga.gov.

From the Commissioner Patient-centered Medical Homes: Saving Costs, Improving Care

Patient-centered medical homes are gaining in popularity here in Georgia - and for good reason. They save money and improve the delivery of care to patients. The Georgia Department of Community Health (DCH) has begun a Performance Improvement Project (PIP) to address avoidable use of emergency rooms among Medicaid-eligible members ages 0 through 20.

Increasing two-way communications between hospital emergency departments and primary care physicians will strengthen the concept of patient-centered medical homes for these members.

A DCH analysis of CMO data revealed that ER usage among members of Georgia's CMOs declined from 2009 to 2010. This is a trend we are working actively to continue.

David A. Cook

Janice Carson, MD, Medicaid Deputy Director for Performance, Quality and Outcomes, has undertaken this PIP by reaching out to physicians and hospitals for input and involvement. The project will officially launch on January 1, 2012.

The objectives for the first year of the Avoidable ER Use PIP include:

Clinical information regarding ER visits for the study population will be sent electronically to the primary care provider of record 80 percent of the time. At least a 5 percent reduction over baseline in avoidable ER use will be demonstrated by the end of the first year of the project. 90 percent of PIP providers will offer same-day appointments for routine and urgent care. 75 percent of study participants will provide routine and urgent care appointments available after hours and will document after-hours clinical services in the patient's medical record. A minimum of 50 percent of study participants will utilize Electronic Health Records.

We welcome a continued dialogue to define additional strategies. If you are a physician or a hospital in metro Atlanta and would like to participate in this project, please contact us at DCH-i@dch.ga.gov
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Ask DCH-i

DCH-i received several inquiries and comments following our inaugural issue. We encourage you to "Ask DCH-i" your questions.
Q - DCH-i is a great newsletter. Have you considered including periodic interviews with DCH officials?
A - Thanks for the compliment. Yes, you can count on that in our next issue. Suggestions on who you would like to see interviewed or questions you would like to ask, write to us at DCH-i@dch.ga.gov.
Q - I've been having claims reimbursement issues. Can you assist me?
A - As you know, DCH's fiduciary partner is Hewlett-Packard. The agency migrated its reimbursement system to HP late in 2010, and while there have been some challenges, overall DCH is very pleased with the system. For questions about claims, please contact your HP representative.
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Around DCH
DCH Health Information Technology Hosts Town Hall Meeting December 16
For the latest information about the state of Health Information Technology in Georgia, mark your calendars for Friday, December 16, from 10 a.m. to noon. The meeting will be held at DCH's offices at 2 Peachtree Street in the Fifth Floor Board Room.
The Town Hall meeting will update physicians, providers, vendors, third-party payers and other stakeholders about the Medicaid EHR Incentive Program, the Georgia Health Information Exchange (HIE) and other Health IT initiatives. In addition to DCH staff, presentations will be made by representatives of GA-HITREC and others.

PeachCare for Kids Co-pays on the Horizon
New co-pays for PeachCare for Kids members have been approved by the DCH Board. However, co-pays will not be enacted until DCH receives approval from CMS.
DCH will give 30 days' notice to physicians and all providers of the starting date for these co-pays.

EHR Incentive Payments Continue to Increase
Since September 2011, DCH has sent out nearly $12 million in payments to eligible physicians and eligible hospitals that have registered and qualified as early adopters of electronic health records technology. Georgia's Medicaid EHR Incentive Program is open to eligible Medicaid professionals - physicians, nurse practitioners, certified nurse-midwives and dentists - and eligible hospitals - acute-care hospitals, critical-access hospitals and children's hospitals.
The program has two main goals:
To promote the meaningful use of certified electronic health records to improve the quality, safety and efficiency of patient care, and To reward and support providers as they transition into new technology within the nation's health care system.

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology(ONC) are providing funding and support of the program that was created by the Health Information Technology and Economic and Clinical Health (HITECH) Act as part of the the American Recovery and Reinvestment Act of 2009. DCH officials anticipate a total payout to qualified Georgia providers and hospitals of $480 million over the life of the project.

Registration for the program is required at both the federal level (www.cms.gov/EHRIncentivePrograms) and the state level (www.mmis.georgia.gov). Once eligible participants have attested to meeting all program requirements and their applications have been approved, payments will be made within 45 days.

DCH Deputy Contributes to Medicaid Program Direction

Janice Carson, MD, Deputy Director of Performance, Quality and Outcomes with DCH, recently provided feedback to CMS about the specifications for the CHIPRA Initial Core Set Measures and participated in the selection of the Adult Core Set Measures that will be released by CMS in 2012. Dr. Carson has also been instrumental in creating several programs directly tied to improving health outcomes - Planning for Healthy Babies, designed to reduce the incidence of low birth weight and very low birth weight babies; and the DCH Patient-centered Medical Home Initiative, a primary-care oriented approach that organizes care around patients and requires providers to work in teams, coordinating and tracking care over time.

Dr. Janice Carson

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Medicaid Update
Medicaid and CHIP Redesign Initiative
By the numbers: Thirty focus groups in 12 Georgia cities provided in-depth input in the assessment phase of DCH's Medicaid and CHIP Redesign initiative. Held in October and November, focus groups included physicians, provider associations, consumers, advocates, hospitals and providers specializing in the following services: behavioral health, durable medical equipment, pharmacy, dentistry, long-term care, home- and community-based services, and home health. Additionally, the CMOs and noncontracted vendors participated in focus groups. Nearly 400 people completed the online survey about the redesign.
The strategic recommendation report is due in January 2012. Please visit www.dch.georgia.gov/medicaidredesign.
Eligibility System Project
With a launch target of January 1, 2014, Georgia is moving forward on an interagency Medicaid Eligibility System. The Georgia Department of Community Health, the Georgia Department of Public Health and the Georgia Department of Human Services are working cooperatively to develop the eligibility portal for applicants to Medicaid and PeachCare for Kids and other programs.
Issues being addressed include identification verification, eligibility assessment and interagency information sharing.
The new system will first address the expansion of Medicaid and the influx of new Medicaid members eligible for the program under the Patient Protection and Affordable Care Act. This expansion is expected to increase Georgia's Medicaid rolls by more than 650,000 members between 2014 and 2020. Other populations will follow through the new portal, including SNAP, TANF and WIC.
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Georgia Medicaid Recognized Nationally
Georgia's Medicaid and PeachCare for Kids programs have been recognized for Quality Measurement and Reporting. Secretary of Health and Human Services Kathleen Sebelius featured Georgia in the 2011 Annual Report on the Quality of Care for Children in Medicaid and CHIP. The programs are managed by DCH.
Medicaid and the Children's Health Insurance Program (CHIP) are a major source of health coverage for low-income children ranging in age from infants to early adulthood. Together, these programs provide coverage for about 40 million children nationally each year with access to a comprehensive set of benefits. In Georgia, these preventive, primary care and other medically necessary services are provided to more than 200,000 children enrolled in PeachCare for Kids. Together with Medicaid, these programs provide health coverage to nearly 1.7 million Georgians.
"Georgia reported 18 of the initial 24 CHIPRA measures in FY 2010, more than any other state," the report said. "Moreover, the state actively uses the quality measures to assess Managed Care Organizations' achievement against targets, develop performance improvement plans, and enforce contractual provisions related to quality of care. Georgia has taken a proactive role in designing its data systems to support quality measurement at the state level."
Georgia was the only state featured in the State Spotlight section of the report. In addition, the state was also credited with an 8 percent increase in the number of children receiving preventive dental services from federal fiscal year 2000 to 2009.
"Georgia Medicaid and PeachCare for Kids programs are taking an active role in providing access to affordable health care for our underserved and uninsured Georgians," said DCH Commissioner David A. Cook. "Much of our program success is due to the forwardthinking, results-oriented and innovative leadership demonstrated by our Medicaid team."
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ICD-10 Transition Continues - Are You Ready with 5010?
The clock is ticking toward the January 1, 2012, deadline to be tested and ready to file HIPAA claims via 5010 transaction codes, the precursor to ICD-10. If you're not tested and ready, you will be at risk for claims rejections and cash-flow interruptions.
A number of providers across the state have already been filing their claims using 5010 codes.
"The transition was really a pretty clean process with no system issues," said Linda Lockhart with LabCorp, headquartered in Burlington, N.C. "Georgia was the first state Medicaid program where we tested as "ready." In fact, we're already filing our claims with Georgia using 5010."
LabCorp began testing 5010 in early 2011 with a small number of payers. By late spring, the company was processing claims with no issues. With six people dedicated to processing more than 2,000 Georgia claims each month, LabCorp did minimal training.
"After a few meetings and in-house training, we were ready to go," Lockhart said. "The HP system is intuitive and very easy to use."
Lakita Lyman with Sadie G. Mays Health and Rehabilitation in metro Atlanta is also tested and ready for 5010.
"We downloaded the 5010 software in about 15 to 20 minutes," said Lyman, who files nearly 150 claims per month for the skilled nursing and residential rehabilitation facility. "Hewlett Packard gave us great help and support from the time we purchased our Provider Electronic Solutions (PES) software through the completion of the testing process. And since we've been using 5010, I haven't had to call them for anything."
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Medicaid Telemedicine Summit Highlights
The Internet is bringing health care professionals directly to patients in Georgia's rural and underserved areas, thanks to the advancements of telemedicine. In fact, Georgia is becoming a go-to resource for other states as they implement telemedicine programs to improve access to affordable quality health care. Georgia's telemedicine program through the Georgia Partnership for TeleHealth (GPT) is among the most advanced in the nation.
Earlier this fall, Georgia Medicaid hosted its Telemedicine Summit, attended by scores of physicians, hospital executives, health care CIOs, academics, advocates and others. As keynote speaker, GPT CEO Paula Guy reported that nearly 250 sites are currently up and running; 175 of those received grants from GPT.
"We have already created a secure, private dedicated network to connect physicians and their patients directly to specialists across the state," Guy said. "There is no doubt that Georgia is the most robust telemedicine network in the nation. The need is there and further growth is coming."
Guy said that the top telemedicine encounters are related to wound care, adult psychiatrics, gerontology psychiatrics, neurology, child psychiatrics, endocrinology, pediatric endocrinology, rheumatology and dermatology. Additionally, child protective services has begun using telemedicine technology in cases of potential child abuse. On the horizon, the program will be expanded to include strokes, trauma and care in nursing homes. It's also being used in a pilot program with Georgia public schools.
TeleConnect Georgia has provided a $2.5 million grant to increase the number of telemedicine sites in the state and will offer online courses, including Introduction to Broadband, Physicians Practice Training, MEDIPORT Quick Start Reference Guide, HIPAA Privacy and Security, Continuing Medical Education and more.
"Telemedicine will reduce the cost of health care and improve health outcomes," Guy said. "And, most importantly, this technology brings world-class care to rural communities."
Erica Dimes, program director for Georgia Medicaid's TeleHealth/Medical Policy, explained the Medicaid policies regarding the use of telemedicine and reimbursement for related services. She also solicited comments from attendees, which ranged from consideration of paying facility fees to expansion of covered telemedicine services.
"Medicaid policy is being reviewed to address reimbursement and other issues as providers in the state adopt telemedicine technology," said Georgia Medicaid Chief Jerry Dubberly. "With the technology's improved access to care, it is imperative that we retain and expand our network of providers and help ease their administrative burdens as this technology is adopted."
The Georgia Partnership for TeleHealth's mission is to increase access to health care through the innovative use of technology, including telemedicine, the exchange of health information and telehealth. It promotes improvements in health care and health care facilities in rural and underserved communities throughout Georgia by helping establish telemedicine programs.
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Celebrate National Rural Health Day November 17

state's rural population.

November 17 is the first annual Rural Health Day in the nation - and in Georgia. Celebrating the many contributions of an array of providers to the delivery of quality affordable health care to otherwise underserved populations, the program is designed to draw attention to the continuing needs of each

More than two million people live in rural areas of Georgia. Of the state's 159 counties, 109 have populations of less than 35,000. In those areas, citizens may lack access to primary care physicians, dentists, hospitals and other health care providers.

Thanks to DCH's State Office of Rural Health (SORH), under the leadership of director Charles E. Owens and his staff, Georgia's rural population has an avid guardian. The SORH provides a conduit to both federal and state funding to help establish community health centers and federally qualified health centers, as well as identifying and helping meet community needs for physicians and allied health professionals.

Learn more about SORH.

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Speaking Up!
Commissioner Cook will address these organizations during November and December: November 18 - HomeTown Health -- www.hometownhealthonline.com December 6 - Georgia College of Emergency Physicians -- www.gcep.org

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Blake Fulenwider Joins DCH

Blake Fulenwider has joined DCH as Deputy Commissioner. With a strong background in health policy, both statewide and federally, Fulenwider brings a wealth of experience to DCH.

"I have worked with Blake for a number of years and am delighted he will be serving on our senior management team," said DCH Commissioner David Cook. "With DCH's responsibility for a number of incredibly large programs and complex projects, a person of Blake's caliber, background and experience will be a real plus for us."

At DCH, Fulenwider will assist the Commissioner with programmatic oversight, support and management. He will provide guidance and support for the Medicaid Division and the Office of Health Information Technology. The Deputy Commissioner will also play a lead role in the Georgia Health Insurance Exchange.

Blake Fulenwider

Fulenwider comes to DCH from Gov. Nathan Deal's office, where he served as the governor's chief health policy

adviser. He also served Gov. Deal in Washington, D.C., in a similar role when then-Congressman Deal was the

chairman (and ranking member) of the Health Subcommittee of the Energy and Commerce Committee. His

work on legislation includes the Patient Protection and Affordable Care Act (PPACA), Children's Health Insurance Program Reauthorization

Act (CHIRPA), Ryan White HIV/AIDS Program Reauthorization Act, food safety and biopharmaceuticals.

In addition to his policy advisory role, he chairs the Georgia Health Insurance Exchange Advisory Committee and serves on the board of Georgia Health Information Exchange Inc.

Fulenwider is a native Georgian and a graduate of the University of Georgia with a Bachelor of Business Administration/Finance.

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Editor-in-Chief Pamela A. Keene
Graphic Design Karen Rothschild
Production Iris McIlvaine
Circulation Denise Smith
Peggy Woodruff Interim Director of Communications
About the Georgia Department of Community Health
DCH conducts the business of health care for Georgians. Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and underserved populations.
DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit Plan, Healthcare Facility Regulation and Health Information Technology in Georgia.
We are dedicated to A Healthy Georgia.

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