Organization and Planning Grant Requirements

Phase One National Press Release

Health Care Central Georgia, Inc.
Macon, GA

April 2000

               Background

Formal efforts to assess needs and build collaboratives at the county level have been in place since the early 1990's.  The Medical Care of Central Georgia (MCCG) received support from the Macon-Bibb County Hospital Authority to conduct a comprehensive Community Health Assessment for the County to identify areas in which the healthcare delivery system did or did not meet the needs of the indigent, uninsured and underinsured.  In 1996, Houston County established the community-based Houston County Indigent Task Force to research, analyze and develop an efficient and effective system of care for the uninsured and underinsured in the county.  Concurrently beginning in 1996, individual counties began to form Family Connection Collaboratives as part of the Georgia Policy Council Network.  These Collaboratives foster communication, cooperation and coordination of the technical assistance for strategic planning, data collections, analysis and evaluation.  Collaboratives are now in all seven counties.

In 1998, the United Way of Central Georgia partnered with the Medical Center of Central Georgia to conduct a regional community assessment with the goal of creating a regional agenda for health services.  This initiative was a major step forward in bringing together healthcare providers, governmental entities, social service agencies and consumers to identify healthcare needs.  The result of this process was the "Regional Community Assessment:  Creating Community Agendas for Health and Human Services."

Based on previous efforts spurred on by The Robert Wood Johnson Foundation Communities in Charge Initiative, the Health Care for Central Georgia Collaborative began meeting in March 1999.  The Collaborative is broad-based, open and unlimited in membership.  It meets four times a year and participation is encouraged from healthcare providers, public health, governmental entities, educational institutions, social services, business' the faith community, legal services, civic groups, advocacy groups and concerned citizens.

A Board of Directors consists of 21 members.  It is responsible for policy and management functions.  Included in the membership are:  4 hospital CEO's 7 elected commissioners (one from each of the counties represented), the Regional Health Director, a representative from Georgia Legal Services, and 4 physicians (3 primary and 1 specialist), and 4 community members drawn from civic organizations non-profit agencies, physicians, advocacy groups, faith groups, and others.  The full collaborative confirms and elects the Board.

Care to the uninsured is currently delivered through a patchwork and expensive system.  The Medical Center for Central Georgia maintains Neighborhood Health Centers in 3 high-risk communities.  These centers provide primary care on a sliding fee schedule to Bibb County residents.  Additionally, MCCG operates an ambulatory care clinic adjacent to the hospital.  Preventive maintenance, specialty and pharmacy services are provided for Bibb County residents.  Over $12 million in in-patient indigent care is also provided.  Houston Healthcare Complex maintains a Medical Assistance Program (MAP) to assist uninsured Houston County citizens.  The program focuses on care management for high-risk patients in the areas of hypertension, diabetes and respiratory disease.  Additionally, the program provides pharmacy assistance for those who cannot afford prescribed medications.  While these programs are commendable, it is evident that no healthcare organization in and by itself has, or can develop, a single solution for serving this population.  The solution lies in the ability to develop a multi-organized team to finance and develop solutions through a well-planned network to manage, educate and deliver services.  

 

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         Guiding Principles



Our community will develop an enrollment-based program with emphasis on primary care to serve both adults and children who lack one or more of the following:  

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       Initial Project Objectives

Health Care Central Georgia intends to run the concept "managed care" on its head.  Instead of seeking the good risk, the project plans to make a concerted effort to identify and serve those who are considered bad risks.  In other words, HCCG is looking to identify those uninsured persons with chronic conditions who cost the healthcare system unnecessarily because their care is uncoordinated and sporadic.  Primary care is usually absent, and treatment occurs when conditions are acute.  The project will mine medical records at local hospitals and physician offices to identify those with chronic conditions who will best benefit from active coordination of their conditions.  By allowing hospitals and other providers to have the flexibility to provide care in a range of settings, as part of a coordinated plan of treatment, scarce resources will be used in a more efficient and effective manner, and people will receive higher quality care.  

Another aspect of the project that will be explored is taking advantage of insurance coverage provided by employers.  The feasibility of vouchers for working individuals and families with access to employer sponsored and subsidized insurance will be assessed.  The Central Georgia community strongly believe in building off the private sector efforts rather than supplanting them.  The technical details of making this portion of the project work are complex, but the community is committed to pursuing the feasibility.

A final aspect of the design is improving access to healthcare for people living in rural areas.  Five of the seven counties involved in this effort are rural.  The project expects to build on two existing efforts.  One is the Medical College of Central Georgia's Telemedicine Program.  Using telemedicine to connect specialists from our tertiary care centers with primary care providers enhance quality of healthcare.  The other resource is the Georgia Rural Enrichment and Access Program (REAP) for health based at Mercer University.  Mercer has a grant through the Robert Wood Johnson Foundations Southern Rural Access Program and attempts to:

  • Create a cohesive element among state and local stakeholders that integrates communication and access to technical information, addressing common concerns strategically and;

  • Develop a proactive as well as a responsive approach to engaging rural communities around the development and implementation of strategic healthcare delivery plans.

The cornerstone of REAP is the development of rural health networks.

 

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        Financing & Outreach Strategy

Financing Strategy

A central source of funds is in the Medicaid disproportionate share funds.  Freeing a portion of these funds from hospital settings would make them available to cover medical services of other providers.  The hospitals also annually provider over $14,000 in uncompensated indigent care.  As this project is implemented to manage the delivery of healthcare to the uninsured, it is expected that the financial burden to the hospitals will be reduced.  This decrease will allow the hospitals to become more creative and proactive.  Our newly elected governor, Roy Barnes, is also committed to expanding access to healthcare coverage.  It is anticipated that other state funds especially those resulting from the tobacco settlement, will be earmarks to assist the HCCG project.  The program will investigate potential waivers in the administration of Medicaid funds.

Outreach Strategy

The process that identifies the target population i.e., those with chronic conditions and no health insurance will facilitate outreach.  Patient types will have already been identified.  Beyond that, we will depend on healthcare practitioners to act as publicists.  Further, we will rely on local Chamber of Commerce to interact with the employer community.  A general marketing/public awareness campaign is also planned.

Delivery System

The premise for the infrastructure design is straightforward; the central Georgia community proposes to restructure the current inefficient, fragmented, institution-based healthcare system for the uninsured by incorporating managed care techniques and insurance principles into the delivery system.  Allowing hospitals and other providers to have the flexibility to provide care in a range of settings will be more efficient and result in higher quality.

Sophisticated networks of hospitals, other providers, and managed care frameworks already in place will be utilized to facilitate the delivery of services.  Central Georgia Health Network represent over 350 predominately primary care physicians.  Secure Health Plans incorporates Local Provider Organizations, comprised of community-based-not-for-profit hospitals and their respective medical staffs, and own a provider-sponsored healthcare corporation that should be activated as the vehicle to manage a captivated system.  Central Management Services is a network of 28 physicians focused on the delivery of primary care with an emphasis on rural Central Georgia.  Finally, both Houston Healthcare Complex and The Medical Center of Central Georgia have broad networks of outpatient clinics that support the services at their core facilities.

The project seeks to formulate a hospital-centered managed care network model.  It is anticipated that a variation of managed care insurance products will be designed.  It will incorporate patient-centered managed care principles and techniques, such as case management, provider networks, utilization management, claims management and risk evaluation.  Central Georgia's restructured healthcare delivery system for the uninsured will offer patients the benefit of a system focused on appropriate care rather than on maximization of costs determined by inappropriate care settings.

Four basic managed care aspects to be refined are:

  • A system in which participating hospitals and other providers have the flexibility to determine those uninsured cases appropriate for a coordinated treatment plan and increased flexibility to deliver these services in a variety of settings.

  • Case management techniques for those uninsured patients with diagnoses amendable to such intervention.

  • As expanded network providers, centered on hospitals, to care for uninsured patients.

  • Performance measures for the networks and providers, and a system for evaluating patient health outcomes.

         Challenges

The Central Georgia community is diverse.  The core challenging will be to coalesce the community around trust in common strategy to address the issue of improving access to care for the uninsured.  With seven counties, one major urban center and one minor urban center HCCG will have numerous institutional and territorial barriers to overcome in order to succeed.  Great emphasis will be placed on process.  the Board of Directors and Collaborative will have broad representation.  Communication will be the key; we expect the project manager and involved community leaders will need to expend significant energy to ensure political buy-in by all interested parties.  Organizing and producing the grant application was a good dry run.  It showed that the Community has the necessary commitment to address the issues.

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       Demographics

Geographic Area - Seven central Georgia counties

  • Bibb and Houston (urban hub), Crawford, Jones, Monroe, Peach, Twiggs (rural)

Population - 344,7000

Uninsured Population - 60,670 or 17.6% based on Census Bureau report of uninsured in Georgia

Target Segment of Uninsured - Individuals and families with incomes up to 300% of the federal poverty level who do not qualify under governmental health insurance programs such as Medicaid or PeachCare (CHIP).

 

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        Contact Us

Shannon T. Harvey, LCSW, ACSW
President & CEO
Health Care Central Georgia, Inc.
233 Medical Court
Forsyth, GA 31029
Phone: (478) 994-1914
Fax: (478) 994-8302
E-mail:  shannon_hccg@hotmail.com

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 Communities In Charge 2002 is a program of The Robert Wood Johnson Foundation.
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