The document outlines data from The Commonwealth Fund on Georgia's health care system performance compared to other states, showing that Georgia ranks poorly on access, costs, and prevention. It then discusses strategies from successful programs that focus on coordinating care for high-need, high-cost patients through methods like home visits and individualized care plans. Examples are provided of programs that have reduced health care utilization and costs through these patient-centered approaches.

1. Georgians for a Healthy Future
Atlanta, Georgia
January 10, 2019
Annual Legislative Breakfast:
Health Care Unscrambled
David Blumenthal, MD, MPP
President, The Commonwealth Fund

2. 2
1. Introduction
2. Georgia by the numbers
3. Strategies for improvement
Agenda

3. 3
https://www.commonwealthfund.org/publications/maps-and-
interactives/2018/may/health-system-data-center

4. 4
National Map of State Ranking by
Quartile
Source: Health System Data Center, The Commonwealth Fund, 2018.

5. 27%
17%
21%
12%
0%
5%
10%
15%
20%
25%
30%
Adults without a usual source of care (2016) Adults who went without care because of cost (2016)
Access
Alabama
Tennessee
Georgia
Source: Health System Data Center, The Commonwealth Fund, 2018.
Georgia Compared to the Best Comparable
State in the Southeastern U.S.
Georgia

6. 197
68
189
62
0
50
100
150
200
250
Potentially avoidable ED visits among Medicare
patients (2015)
Preventable hospital admissions for patients age 75
and older (2015)
Cost
Georgia
South
Carolina
Source: Health System Data Center, The Commonwealth Fund, 2018. Data is per 1,000 Medicare beneficiaries.
Georgia Compared to the Best Comparable
State in Southeastern the U.S.
Georgia South
Carolina

7. 34%
66%
28%
58%
0%
10%
20%
30%
40%
50%
60%
70%
Adults without age- and gender-appropriate cancer
screenings (2016)
Adults without age-appropriate vaccines (2016)
Prevention
North
Carolina
Source: Health System Data Center, The Commonwealth Fund, 2018.
Georgia Compared to the Best Comparable
State in Southeastern the U.S.
Georgia
Georgia
North
Carolina

8. 6.7%
5.7%
3.5%
5.3%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Expansion States Nonexpansion States
2012 2015
Source: A. Dobson, J. E. DaVanzo, R. Haught et al., Comparing the Affordable Care Act’s Financial Impact on
Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not, The Commonwealth Fund,
November 2017.
Uncompensated Care Costs as a Share of
Safety-Net Hospitals’ Operating Expenses
Dropped Substantially Only in Medicaid
Expansion States

9. 9
Market Concentration Levels Across
the United States
Brent D. Fulton, Daniel R. Arnold, and Richard M. Scheffler, “Market Concentration Variation of
Health Care Providers and Health Insurers in the United States,” To the Point (blog),
Commonwealth Fund, July 30, 2018.
3.6%
36.9%
54.5%
5.0%
Health insurer market
concentration
0.3%
9.6%
47.1%
43.0%
Health care provider
market concentration

10. 10

11. 11

12. U.S. population Health expenditures
Source: Agency for Healthcare Research and Quality analysis of 2013 Medical Expenditure Panel Survey; MEPS
Statistical Brief 480.
Health Care Costs Concentrated in Sick Few—
Sickest 5% Account for 49% of Expenses
5%
49%

13. 13
1. Stratify patients by common needs
2. Invest in care coordination
3. Shift care from institutions to community
4. Integrate medical, behavioral, and social services
5. Give providers flexibility in allocating resources
Strategies to Care for High-
Need, High-Cost Patients
G. F. Anderson, J. Ballreich, S. Bleich et al., “Attributes Common to Programs That Successfully
Treat High-Need, High-Cost Individuals,” American Journal of Managed Care, November 2015.

14. 14
Program
• Founded in 1993; acquired by Anthem in 2011
• HMO operating MA plans and delivery sites in 6 states
• Care management system being piloted by health system, two
Medicaid programs
Key elements
• “Extensivists” lead care team for high-risk patients
• Adopt innovative technologies (e.g., partnership with Lyft)
Results
• Reduced hospital readmissions, ~50% fewer SNF days
• Preliminary analysis shows lower costs
CareMore Program

15. 15
Program
• Health plan & network with 60+ sites in Massachusetts
• Serves 17,000+ disabled adults & frail elderly
Key elements
• Interdisciplinary team with home visits
• Individualized care plans
• Blended Medicare and Medicaid funding
Results
• Reduces hospital and nursing home use; improves care experiences
Commonwealth Care Alliance

16. 16
http://www.bettercareplaybook.org/

17. 17
http://www.commonwealthfund.org/roi-calculator
ROI Calculator for Partnerships to
Address the Social Determinants of
Health

18. 18
ROI Examples
$4,334
in savings
(per patient per month)
Avoidable
Utilization
$5,177–7,857
in savings
(per patient per month)
Blood-Sugar Levels
$3,423
in potential savings
(per patient per month)
Patient Adherence

19. Question and Answer