Department of Medical Assistance Georgia Better Health Care Program (Atlanta, GA)

The Pacific Health Policy Group (PHPG) was retained to assist the Department of Medical Assistance in developing a partial capitation program for the state's existing primary care case management system, known as Georgia Better Health Care (GBHC). Specific tasks related to this project included:

• Development of program participation and operational standards

• Design of the capitated benefit package and a provider incentive program

• Development of the fee-for-service equivalencies and upper payment limits for the program

• Drafting of the 1915(b) Waiver addendum to modify the existing program

• Providing technical assistance to the Georgia State University's Health Policy Center on the structure of an educational program for physicians on practice management in a capitated environment

• Working with the Medical College of Georgia to design a disease management program as a part of the GBHC initiative

PHPG also assisted DMA in the drafting of its Title XXI SCHIP application, and in developing an implementation plan for the program, to be known as Georgia PeachCare for Kids. Specific implementation activities included:

• Assisting the state in formulating enrollment and expenditure projections

• Drafting a Request for Proposals to procure the services of a Third-Party Administrator, with responsibility for performing eligibility verification, collecting premiums, generating rosters to GBHC providers (who also serve CHIP enrollees), and operating member and provider service functions

• Evaluating proposals and conducting an on-site readiness review of the selected vendor

PHPG also assisted in the design and implementation of Georgia's State Child Health Insurance Program (S-CHIP), known as "PeachCare for Kids". Specific tasks related to this project included:

• Consulting on program design in areas such as benefits, enrollee share-of-cost, and delivery models

• Drafting a Request for Proposals to obtain a third-party enrollment agent for the program

• Evaluating proposals and conducting a pre-operational site visit for the selected vendor