|
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.
→Back
to Top
§ 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:
→Back to Top
§ 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.
→Back to Top
§
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.
→Back to Top
§
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).
→Back to Top
§
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
→Back to Top
|
