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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Donald E. Reed, PhD, School of Health Sciences, Ohio University, E337 Grover Center, Athens, OH 45701, 740-597-1695, reedd@ohio.edu
The State of Georgia established a Medicaid Managed Care Program known as Georgia Better Health Care (GBHC) in 1994. GBHC is a primary care case management form of managed care program into which Medicaid recipients were phased by groups of contiguous counties over a four-year period.
A key goal of GBHC was to reduce unnecessary use of medical services. Prior to the establishment of GBHC, it was perceived by state Medicaid officials that many recipients were receiving primary care services from hospital emergency departments (ED). A significant reduction in ED utilization therefore was a measurable objective of GBHC.
Since GBHC was phased in over an extended period,comparisons can be made for ED utilization rates of GBHC members and non-members. Non-GBHC members had a mean rate of 0.1983 per recipient for the first four quarters of the phase-in period, while the rate was 0.1254 for the first four quarters after phase-in was completed. This represents a 36.8 percent reduction in ED utilization by Georgia Medicaid recipients.
During the first four years of its existence, GBHC paid for ED care only if approved by the recipient's primary care physician. Roughly coincident with completion of the GBHC phase-in, the Balanced Budget Act of 1997 required that reimbursement be made if the Medicaid recipient reasonably believed that emergency care was required. Since the mean utilization rate was 0.1268 for the eight quarters after the phase-in was completed, there is a strongly suggestion that GBHC was successful in permanently reducing unnecessary ED utilization.
Learning Objectives:
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: During a portion of his doctoral program, the author was employed as a part-time data analyst by the Georgia Department of Community Health, the agency which administers the state's Medicaid program.