Talking points Managed Care Quality Strategic Plan

Managed Care Quality Strategic Plan
TALKING POINTS
Managed Care Quality Strategic Plan

Why did Georgia implement Georgia Families?
n In 2006, the state of Georgia implemented Georgia Families, a managed care program through which health care services are delivered to members of Medicaid and PeachCare for KidsTM. The intent of this program is to:
1. Offer care coordination to members 2. Enhance access to health care services 3. Achieve budget predictability as well as cost containment 4. Create system-wide performance improvements 5. Continuously and incrementally improve the quality of health care and services provided to
members 6. Improve efficiency at all levels

Georgia Families Membership Overview:

n Managed Care by the numbers: 1. As of February 2008, 922,604 members were in enrolled in Georgia Families 2. Georgia Families program includes 56 percent of Medicaid and 93 percent of the PeachCare for KidsTM population which is just shy of one million members 3. The majority of the members within Georgia Families are children: o Approximately 68 percent of the Georgia Families members are less than 12 years of age o Approximately 87 percent of the Georgia Families members are less than 18 years of age

Managed Care and Quality Strategic Plan Background:

n The Social Security Act requires each state to implement a Quality Strategic Plan to ensure the delivery of quality health care by all Managed Care Organizations
n The state has undertaken the creation of a Managed Care Quality Strategic Plan to reach established program goals and ensure beneficiaries have access to quality health care in managed care programs by continuously assessing, reviewing and revising the state's quality strategies
n The Centers for Medicare and Medicaid Services (CMS) requires each Quality Strategic Plan to, at a minimum, include the following sections: 1. Introduction o The state's decision to implement Managed Care o Description of the process to receive public input o Performance Driven Objectives targeted for performance improvement 2. Assessment
o An evaluatation of the quality and appropriateness of care and services delivered to Georgia Families members

2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov

January 2008

Managed Care Quality Strategic Plan
o Care Management Organizations (CMO) contractual and regulatory compliance
m Division of Managed Care and Quality's management unit defined 46 performance measures as one method of monitoring CMO compliance
o Health Information Technology and Transparency (HITT) changes/evolution on the level of impact of Georgia Families program
3. Improvement o Performance Improvement Projects m Five clinical w EPSDT screens; w Immunizations; w Blood lead screens; w Detection of chronic kidney disease; and w Emergency room utilization m Two non-clinical w member satisfaction w provider satisfaction m Incentives w Financial incentives when performance expectations exceeded w Supportive feedback on quality monitoring w Personalized recognition of satisfactory service m Intermediate Sanctions w May be implemented in cases where the process or indicator reviewed does not reach performance standards w Corrective/Preventive Action Plan
4. Review o Quarterly assessments of performance o Annual report of performance submitted to CMS
Goals and Objectives of the Managed Care Quality Strategic Plan:
n It is the goal of DCH to assure that the care provided within managed care is of acceptable quality, accessibility, continuity and efficiency
n The purpose of the Quality Strategic Plan is an explanation of how Georgia will assess the quality of care delivered through the CMO and based on this assessment, how Georgia will improve the quality of care delivered to the members in the program
n The state of Georgia will use a process to develop, review and revise Georgia Medicaid's quality assessment and improvement strategies that includes internal meetings with key decision makers and external meetings with stakeholders
n The Quality Strategic Plan will focus on quality performance measures for eight health topic areas including: 1. Access to Preventive /Ambulatory Health Services 2. Asthma 3. Behavioral Health 4. Children's Preventive Health 5. Diabetes 6. Oral Health 7. Utilization Rates 8. Women's Health Care Services

Managed Care Quality Strategic Plan

The assessment of the plan and the evaluation of each of the performance measures will serve as the basis for implementing systems and processes that will improve the quality of care delivered to the citizens enrolled in the Georgia Families program.

Strategic planning partners and key stakeholders DCH will partner with to move the Quality Strategic Plan forward include, but is not limited to the following:

Georgia Childhood Lead Poisoning Prevention Program PeachCare for Kids Eligibility Office of Health Improvement (OHI) within DCH State Health Benefit Plan (SHBP) Amerigroup Peach State WellCare HITT unit within DCH Thomson Healthcare (formerly known as Medstat) Voices for Children Healthy Mothers, Healthy Babies Family Connection DHR NCQA Centers for Health Care Strategies, Inc. Georgia Chapter of AAP Allergy and Immunology Society of Georgia Emergency Physicians/Neurological Society/Otolaryngology
Society/Dermatologists Society Gastroenterologic -Endoscopic Society/Nephrology Society Georgia Academy of Family Physicians Georgia Association of Chain Drugstores Georgia Association of Community Service Boards

Georgia Chapter American College of Cardiology Georgia Chapter American College of Surgeons Georgia Dental Association Georgia Dental Society Georgia Health Care Association Georgia Hospital Association Georgia Neurological Society Georgia Nurses Association Georgia OB & GYN Society Georgia Orthopedic Society Georgia Osteopathic Medical Association Georgia Pharmacy Association Georgia Rural Health Association Georgia Society of Clinical Oncology Georgia State Medical Association Georgia Urological Association Home-Town Health Medical Association of Georgia Psychiatric Physicians Assoc/Ophthalmology Society
Georgia Cancer Specialists Morehouse School of Medicine DFCS (for Medicaid Members) PSI (for PeachCare Members)