State Medicaid Officials Aim to Lower Costs With Case Management System

In an effort to control those costs, state officials are developing a type of case management system.

“What we consistently heard from stakeholders and advocates was that our members needed better care coordination,” said Jerry Dubberly, head of Georgia’s Medicaid program.

Dubberly wants the new setup to give primary care doctors and nurses an incentive to keep a closer eye on patients – before urgent issues arise and a costly emergency room visit is needed.

“One of the goals here would be to connect patients with a medical home,” said Dubberly. “To identify if we do have that member going to the emergency room an inordinate amount of time – that we find out the reasons.”

Medicaid is the joint state-federal health program for the poor and disabled.

In Georgia, children and pregnant women – which make up the majority of Medicaid’s 1.7 million beneficiaries – already receive managed care through one of three care management organizations that contract with the state.

State officials had been considering shifting the aged, blind, and disabled population into a traditional managed care company, but the idea was tabled this summer due in part to the uncertain fate of the federal health reform law.

Now, the idea is back, but in lighter form. This time it would be optional for beneficiaries. It would also keep intact the current payment method of fee-for-service, or “pay-as-you-go.” Providers would not take on greater financial risk of the patient.

Linda Lowe, an Atlanta-based health lobbyist, says more coordinated care is a good idea, but it involves a significant commitment from the patient’s primary care provider. 

“The question is whether what you’ve got is a nurse line that may be answered by a person in another state, by someone who doesn’t know you, or whether you have access to a nurse who actually knows who you are and can have a more personal conversation,” said Lowe.

The cost of the new system is still being worked out. State officials say because the system seeks to change patient behavior, the initial investment may not result in big savings in the early years, but they’re confident it would eventually come. They’re targeting late 2013 for implementation.