Background: Georgia Better Healthcare (GBHC), Georgia Medicaid's PCCM program, was first administered in seven counties (1993) and implemented gradually until it became statewide (1998). This study hypothesizes that PCCM utilization will decrease in urban communities (traditionally with abundant medical services), since recipients now belong to a gatekeeper and must acquire authorization to seek the services of another doctor. This study also hypothesizes that utilization will increase in rural communities (traditionally with scarce medical services), since recipients who previously had limited access to care now have a medical home. Methods: The hypotheses are examined by analyzing the impact of GBHC on utilization rates (1993 to 1999). Georgia communities were categorized based on their rural or urban status, and impact was summarized for seven utilization measures (inpatient admission, average length of stay, prescriptions, emergency room, outpatient, case manager, primary care, specialist and well child visits). Results: With some exceptions, urban communities demonstrated decreasing utilization rates for all measures, while several rural communities showed increasing utilization rates for all measures. Conclusion: This study provides evidence that Medicaid PCCM programs may decrease over-utilization of services in communities with abundant medical services while increasing utilization in communities with scarce medical services. States will benefit from studying the impact of such programs on a community-by-community basis. Attention should be given to communities that demonstrate the opposite trend of increasing utilization where over-utilization may already be occurring while decreasing utilization in communities that are medically under-served.
Learning Objectives: Learning Objective: As a result of this session, participants should: 1) understand the anticipated impact of a Medicaid Primary Care Case Management (PCCM) program on utilization assessment of rural and urban communities; and 2) explore a methodology for grouping rural and urban communities across an entire state; and 3) review findings demonstrating evidence that PCCM programs may generally decrease utilization across urban communities by limiting access in communities with an over abundance of medical resources, while increasing utilization in some rural communities by increasing access in communities with limited medical resources
Keywords: Rural Health, Urban Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Georgia Department of Community Health, Division of Medical Assistance
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.