Georgia Enhanced Care Program – Provider FAQ

1. Does APS Healthcare have additional information on reimbursement?

The Georgia Enhanced Care Program is not like the CMOs as it does not affect your current reimbursement process. You will continue to bill for services in the same manner for Medicaid members who are in the Disease Management program. The member's Medicaid card will designate that they are a “DM Member”. This statement do not clearly answer the question

2. How do providers communicate the patient care load or fee schedule with the patients?

APS is not responsible for payment of services and has no responsibility for fee schedule or assignment of patient load. Question not clearly answered

3. What is the Georgia Enhanced Care Program?

The GEC Program utilizes a disease management approach to support specific Medicaid members better manage their health issues. Unlike traditional disease management programs that focus on specific disease states, this Program is designed to address the total-health needs of Aged, Blind, and Disabled (ABD) Medicaid patients.

4. How is the APS Georgia Enhanced Care Program coordinated with the state of Georgia ?

Georgia Medicaid has contracted with APS Healthcare to provide the Georgia Enhanced Care Program in Region 1. Our services include disease management, care coordination, and a goal-oriented focus for your patients to achieve the best results from your care plan. We help to provide high quality, clinically relevant, and targeted medical information and education to patients and their health care providers. APS Healthcare is a national specialty healthcare company providing health and medical management services. Our mission is to help people lead healthier lives through the use of evidence based practices and assistance to patients and their providers. APS Healthcare is URAC accredited for our disease management services.

5. Does APS Healthcare have a referral system for patients who require drugs outside physician's protocol? APS Healthcare does not pay for medicines that are out of the physician's protocol; however, APS Healthcare can provide the physicians and members with contact information on low cost, no cost and medication assistance programs. Question not clearly answered

6. Does APS Healthcare have an assessment tool for the providers to sign or fill out?

Assessing Members: APS' Health Coach RNs will complete an assessment of members upon first contact. Additionally, the Health Coach may contact you regarding critical areas of the person's condition to get additional information or share concerns for follow up. Not clearly answered

Assessing our services: APS Healthcare will utilize a Provider Evaluation form to assess the effectiveness of education provided to them by our staff.

7. If providers choose to opt-out will they loose their patients? Unfortunately, if providers choose to opt-out of the APS Georgia Enhanced Care Program their patients will be assigned to a physician who has chosen to opt-in to the program. Not clearly answered

8. How much time and manpower is needed for the APS Georgia Enhanced Care Program on the provider's behalf? The Georgia Enhanced Care Program does not affect your clinical autonomy. The program simply provides additional services for you and your members without additional administrative impact and in most cases will free up staff by providing educational services.

  There are several times when we may contact your office:

• If there are critical issues identified with a member, we will either use fax or phone to send a Clinical Alert.
• If a member has multiple complicating medical/social factors, we will ask that you participate in care planning with us and the member.
• To ascertain that our work with your patient is in keeping with your established care plan
• To verify member contact information (if unknown to us)
• To share provider specific reports that will give you information about the member's progress.

9. What if the provider is a pediatrician, oncologist, or specialty care physician who cares for children ages 0-18?

The Georgia Enhanced Care Program services the Atlanta and North Atlanta areas with a total member population of nearly 53,000, including youth under age 18. All members are offered this program free of charge and our care plans with members will address the range of health care issues experienced by the person including specialty care needs. APS Healthcare provides support to all physicians and providers who are providing care to ABD members concerning their care. Not clearly answered

10. What are the financial incentives for the physicians? APS Healthcare offers a variety of “incentives” for providers.

Financial incentives for:

• Update/confirmation of member contact information
• Participation in 2 care planning meetings annually for targeted very high risk members
• Response to Clinical Alerts sent for significant changes in member's health status
• Community Grants (quarterly) for:
• Computers for health center locations where we station a Health Coach
• Purchase of equipment to improve population practice
• Implementing “evidence based” practices for specific illnesses
• Changes to pharmacy practices as recommended by APS Pharmacist

Additional incentives provided include:

• Offering CME seminars to educate providers and support their efforts to adhere to evidence-based practice guidelines
• Assist physicians/providers in monitoring patients, specifically those with multiple illnesses and multiple providers
• Providing feedback to provider (Fax Alerts), sharing outcomes data
• Fostering communication and collaboration among providers and between patients and providers
• Measuring outcomes (cost and health)
• Providing a framework and motivation for patients to improve self-management of their illness(es)