Managed care programs can best be described as initiatives that are meant to provide better quality care for its enrollees, while cutting budget and making the dissemination of health care more efficient. The aim of managed care programs is to eliminate waste, and make the market more competitive by providing economic incentives that inspire health care professionals to offer more affordable alternatives for their services. In the state of Georgia, there are two primary managed care programs existing within Medicaid – Georgia Families and Georgia Better Health Care. In this essay, I will evaluate the criteria which allow them to be categorized as managed care programs, and establish how much of the Medicaid budget in Georgia will go towards managed care.
The Georgia Families program offers health care services to those individuals or families who qualify for Medicaid. Once enrolled, a member of Georgia Families picks their preferred health plan from the ones available, and is assigned to a primary care physician, or PCP. This PCP will then act as the primary doctor that they contact for whatever they need – if the patient needs to see a specialist, the PCP will then refer them to the appropriate health care professional. The specialists are contractually obligated to see the patients, as part of the Georgia Families program. (“Georgia Families”, 2011)
Georgia Better Health Care is another option for a managed care program within Medicaid in Georgia. Their primary goals are “to improve access to medical care,” “to enhance continuity of care,” and “to reduce unnecessary use of medical services,” all of which fall under the goals of a managed care program. When enrolled in GBHC, you are allowed to pick your primary care case manager, who then provides you with a PCP. The PCP receives a flat fee each month, even when the patient does not see them. (“Georgia Better Health Care”)
In 2008, Georgia spent over $7 billion in Medicaid costs, which is 2.2% of the amount of money it cost to pay for Medicaid in the entire country. Also, as of 2009, 92% of Georgia’s Medicaid was allotted to managed care programs such as the GBHC and Georgia Families, which is much higher than the 71.7% allocation that is the national average. (“Total Medicaid Spending,” 2008) This equates to an incredible show of faith and confidence in the effectiveness of managed care programs in Georgia.
In the 2011 fiscal year, the state of Georgia is budgeting over $3 billion to low income Medicaid, and is increasing managed care Medicaid rebates as per the Patient Protection and Affordable Care Act. (Deal, 2011) This is an attempt to bring more people into the managed care programs, thereby cutting budgets and allowing health care facilities and organizations to behave in a more cost-effective way. The implementation of managed care programs will ideally help compensate for the incredible budget shortfalls that Georgia is experiencing in the coming years, and permit people all across the state to receive adequate health care.
Deal, N. (2011). The governor’s budget report – Amended Fiscal Year 2011. Atlanta, GA:
Governor’s Office of Planning and Budgets.
Total Medicaid Spending, FY2008 – Georgia – Kaiser State Health Facts. (n.d.). Kaiser State
Health Facts. Retrieved February 16, 2011, from http://www.statehealthfacts.org/profileind.jsp?ind=177&cat=4&rgn=12
georgia.gov – Georgia Better Health Care. (n.d.). georgia.gov – Department of Community
Health. Retrieved February 15, 2011, from http://dch.georgia.gov/00/article/0,2086,31446711_31944826_163856802,00.html
georgia.gov – Georgia Families. (n.d.). georgia.gov – Department of Community Health. Retrieved February 16, 2011, from http://dch.georgia.gov/00/channel_title/0,2094,31446711_42144860,00.html