The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69883

Donald E. Reed, PhD, School of Health Sciences, Ohio University, Grover Center E317, 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. Recipients were phased into GBHC by groups of counties over a 16 quarter period.

A goal of GBHC was to reduce unnecessary utilization of medical services. Prior to GBHC, many Medicaid recipients received primary care services from hospital emergency departments (ED.) A significant reduction in ED utilization was a measurable objective of GBHC.

GBHC was phased in over an extended period, making possible comparisons in ED utilization rates between GBHC members and non-members for the total Medicaid population and the TANF, SOBRA and SSI sub-populations. Non-GBHC members had a mean rate of 0.1983 per member for the first four quarters of the phase-in period. Sub-population rates were 0.1707, 0.1811 and 0.2390 for TANF, SOBRA and SSI .

For the four quarter period after the phase-in was completed, utilization rates declined to 0.1254, 0.1163, 0.1118 and 0.1611 for the population, TANF, SOBRA and SSI sub-populations, respectively.

Prior to the fourth quarter of 1996, GBHC paid for ED care only if approved by the recipient’s primary care provider. The Balanced Budget Act of 1997 required reimbursement by GBHC if the recipient reasonably believed that emergency care was necessary. Georgia Medicaid officials were concerned that ED utilization rates would return to pre-GBHC levels, CY99 (last year of available data) mean rates of 0.1264, 0.1355, 0.1178 and 0.1571 for the population, TANF, SOBRA and SSI sub-populations suggest that this has not been the case.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to evaluate the long-term impact of a Medicaid managed care program on emergency department utilization by major eligibility classification goups.

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.