Georgia Health Policy Center¹
at the Andrew Young School of Policy Studies

The Health Policy Center conducts research for the development of health policy recommendations and implementation strategies to improve the health care delivery system in Georgia. Through studies, research and public debate, staff of the Health Policy Center and representatives from collaborating organizations assist in the formulation of health policy. In addition, through its Child Policy Initiative, the Center has expanded its focus to address children's policy issues beyond health care. The 2001 projects of the Health Policy Center included the following subject areas: child well-being, long term care, rural health, policy development, evaluation, and program implementation efforts with the Department of Community Health, Division of Medical Assistance. Several other initiatives are listed below under a general project category. Karen Minyard is the Interim Director of the Health Policy Center, and James P. Cooney, Jr., is Associate Director.

In This Page

• Projects
• Publications 

Projects

Child Well-Being. Monica Herk. The Child Policy Initiative aims to improve child policy in Georgia through applied research and analysis. The Initiative's current efforts are in three areas: children's health, childcare and early learning, and child protective services. The Initiative provides analysis of existing policies and future options, research into best practices, and objective facilitation and support for state agencies involved in children's policy.

Networks for Rural Health. Karen Minyard. Networks for Rural Health is a state level program designed to: (1) assure rural residents of Georgia access to primary health care services in the communities in which they live; and (2) help rural health systems fully participate in networks and thrive as health care delivery becomes increasingly competitive. The Health Policy Center has assembled a team of rural health experts who provide tailored technical assistance, facilitation, mediation, and consultation to participating communities. Collectively, the team has expertise in community development, clinical medicine, hospital financing, strategic planning, economics, managed care, and organizational development. The program deliverables include working with 39 Georgia communities and five networks; developing financial, clinical, and governance leaders; charting health care dollar flows; profiling rural community health systems; providing education from program learnings; and participating in state level rural health system policy making. ($1,400,000)

Identifying Options for Improving the Quality and Cost-Effectiveness of Georgia's Long-Term Services. James P. Cooney, Jr. and Glenn M. Landers. The Identifying Long-Term Care Service Options program was developed immediately subsequent to the founding of the Policy Center in 1995. Over the past six years, its efforts evolved sequentially and "geometrically" and have created some twenty inter-related studies, educational programs, and/or technical assistance sub-contracts with other organizations. Total extramural funding for the overall effort to date has been in excess of $4 million; it is currently funded to continue through 2002. Funding support over the years has come from the Joseph B. Whitehead Foundation, the Georgia Coalition for Health, and the Georgia Department of Community Health.

2001 marked a transition point for two of the Program's efforts: The Long-Term Care Partnership and Improving Care at the End-of-Life for Georgians.

Improving Care at the End-of-Life (CEOL)

In 2001, the CEOL effort began phasing out its various educational, demonstration, and evaluation activities. The products of these activities have, generally, transitioned into actual operation or further study under the auspices of various other Georgia -based organizations.

Final Center CEOL efforts in 2001 included:

• Developing and facilitating an educational and strategic planning conference for Georgia's four medical schools. The objective of the session was to understand the current status of CEOL education and training among the schools and develop cooperative strategies for improvement. Prior to the session, the Center assisted in developing and analyzing a fact and opinion survey of medical school faculty, students, and residents. Dr. Joseph Fins, Director of Medical Ethics of the Cornell University Medical Center (NYC) served as keynoter and facilitator.
• Completing and evaluating a demonstration to improve CEOL in nursing facilities. The very successful outcomes of the demonstration were formally communicated with statewide implementation recommendations to the Georgia Nursing Home Association, the Georgia Hospital Association, and the Georgia Medical Directors Association. Center personnel were also invited to address committees of those associations concerning the recommendations and development of operational programs.
• Continuing funding to the Georgia Academy of Family Practice to allow them to continue their CEOL educational efforts among their members for another two years.
• Developing and facilitating the 3rd Annual Meeting of the Georgia Collaborative to Improve CEOL, attended by more than 125 individuals from over 50 organizations.
• Final Choices: Changing a Culture, developed by the Center in conjunction with Georgia Public Television, was the recipient of a Southeastern Emmy Award, a National Headliner Award, and a Georgia Association of Broadcasters Award in 2001.
• Products from CEOL study findings and outcomes have begun to appear:
• "Improving End-of-Life Care in Nursing Facilities", a presentation at the annual meeting of the Association for Health Services Research, June 2001;

• In cooperation with the Georgia Medical Directors Association, a computer-based CEOL continuing education program has been developed for distribution to the state's Nursing Facility Medical Directors;

• Two proposals submitted to the American Medical Directors Association meeting in 2002 were both accepted for presentation.

Long-Term Care Partnership

During the background development period (1998-99) of the CEOL nursing facility demonstration, initial analyses of patient care patterns and their financing revealed an unanticipated series of outcomes that were potentially indicative of problems related to quality and cost-effectiveness. These included significant numbers of frequent and rapid transfer of frail elderly patients between the nurse facility and hospitals. Many of such transfers also appeared to be for preventable problems (e.g. community acquired pneumonia). The majority of provider payments for long-term nursing facility care come from Medicare and/or Medicaid. Which of these programs was paying for a particular case also seems to be related to observed differences to care patterns.

Such findings, even though preliminary, were of interest to the Georgia Department of Community Health (DCH) and the federal Centers for Medicare and Medicaid Services (CMS). The Center proposed to DCH an expansion of the original nursing facility study on a larger population for a more recent period and a larger database. The proposal was funded in March 2001 for a sixteen month period in the amount of $840,000.

The principal databases for the study were all Medicare and Medicaid claims for 43,819 individuals admitted to either a Georgia nursing facility or home/community-based program during the year 1999; these individuals' use of care for the years 1998 and 2000 will also be analyzed. The three objectives of the study are:

• For the purpose of providing information to assist in improving resource allocation decisions, comparatively evaluate cost and quality outcomes among Georgia community and facility-based long-term care (LTC) programs;
• Within Georgia long-term nursing facilities, identify opportunities for improving continuity of care;
• Develop a longitudinal and integrated database of Georgia Medicare and Medicaid claims to facilitate analyses of care patterns, quality outcomes, and costs among community and facility-based long-term care programs.

An advisory committee to the Partnership comprised of major long-term care stakeholders in Georgia has been formed.

As of this writing, the shipment of the Medicare data is anticipated in the near future, which will permit the full analytic phase of the study to proceed.

Access to Health Care for Uninsured Georgians

Health Care Central Georgia. Tina Anderson Smith and Karen Minyard. The MedCen Foundation, a community health foundation in Macon, GA contracted with the Health Policy Center to manage and facilitate the development of a regional initiative to improve access to care for the uninsured in seven (7) counties in central Georgia. Health Policy Center staff assisted Health Care Central Georgia (HCCG), a Robert Wood Johnson Foundation "Communities in Charge" Phase I grantee, in designing an enrollment-based program that addresses the needs of the most vulnerable of the uninsured: those with low incomes and high risk medical conditions. Based on the program's design, HCCG was awarded a Phase II RWJ grant of $750,000 over the next three years. HCCG continued to contract with the Health Policy Center to provide ongoing technical assistance and outcome evaluation. ($46,900)

Projects Under a Multi-year Contract with the Georgia Department of Community Health's Division of Medical Assistance Related to Policy Development, Evaluation and Program Implementation 

Evaluating Georgia Indigent Care Trust Fund Primary Care. Glenn M. Landers. Under contract to the Georgia Department of Community Health, the Health Policy Center began a three-year evaluation of participating hospitals' plans for and uses of the primary care portion of Indigent Care Trust Fund (ICTF) dollars. Georgia's ICTF represents the largest component of disproportionate share hospital payments distributed through Georgia Medicaid.

Georgia is the only state that requires hospitals to allocate fifteen percent of its ICTF dollars to primary care services. Ninety-two hospitals participated in the program in 2001, accounting for $54,801,874 in primary care expenditures. The goal of this evaluation is to determine hospitals' compliance with policies and primary care plans, the degree to which ICTF dollars are having an impact on the health status of local communities, and whether or not eligible recipients are receiving services. ($242,900)

Evaluating Georgia's Children's Health Insurance Program (CHIP). Katherine Gardner (formerly Jennifer Edwards) and Jay Bae. The Health Policy Center is evaluating Georgia's health insurance program to serve low-income children, PeachCare for Kids. The evaluation assesses the program's effectiveness in achieving several goals: improved access to insurance, improved access to primary care, access to high quality health services, and better health outcomes. The evaluation includes original data collection through surveys of new enrollees and applicants; evaluation of health insurance claims data; and a process evaluation of the implementation of the program. Results will support policy and program development at DMA, and will also be reported to the Health Care Financing Administration, to be combined with results of other state CHIP programs.

Improving Outreach and Community Participation in PeachCare for Kids and Medicaid. Mary Ann Phillips. In the final year of this contract, Health Policy Center staff coordinated several activities related to increasing the enrollment of uninsured children in PeachCare for Kids and Medicaid. These activities included the development of materials that explain the Georgia Better Health Care Program, and the Spanish translation of handbooks that explain the Medicaid and PeachCare for Kids programs. ($75,000)

General Projects

Grant from the Agency for Health Care Quality and Research (AHQR) and the Packard Foundation. David Rein (formerly Jennifer Edwards). The Health Policy Center, in collaboration with faculty from Emory University and the University of Alabama at Birmingham, was awarded a multi-year grant to study children's health insurance. The three-year study has examined the effect of the federal Children's Health Insurance Program (CHIP) and changes and expansions in Medicaid in Alabama and Georgia on access to care. The study focused on provider availability and low-income children's subsequent access to, utilization of, and satisfaction with health services. 

Grant from the United Parcel Service Foundation. Monica Herk (formerly Jennifer Edwards) and Lauren Waits. The Andrew Young School of Policy Studies received a two year grant from the United Parcel Service Foundation to explore the concept of establishing a children's policy research center that conducts academically sound research related to the issues facing Georgia's children. The program contributes to scientific knowledge about children and to the policies that guide children's programs in Georgia. Before the start of the 2002 legislative session, the Health Policy Center distributed issue briefs to policymakers in the legislative and executive branches on child care and early education. ($125,000)

Philanthropic Collaborative for a Healthy Georgia. Mary Ann Phillips and Jim Ledbetter. Representatives of the Georgia philanthropic and corporate foundation communities have joined forces to enhance the ability of foundations to identify, fund, and evaluate health grant-making opportunities throughout the state. The effort has become known as the Philanthropic Collaborative for a Healthy Georgia. The Health Policy Center serves as the administrative and technical home for the Collaborative. One of the exciting developments resulting from this foundation initiative is a Matching Grants Program. As a means of building a public/private partnership between the Georgia Department of Community Health and the foundations, the Department provides state money to be used as a match for foundations and communities in responding to mutually agreed upon priority health care needs. The Health Policy Center, in its role as coordinator of the activities of the Philanthropic Collaborative serves as the liaison between the foundations and the Department of Community Health. During 2001, Center staff managed two separate matching grants programs that addressed school health ($975,000) and access to rural health care ($2,000,000). Staff developed the request for proposal, coordinated the review process, awarded the grants, and will monitor and provide technical assistance.

Publications

Newsletters and briefs prepared by the Georgia Health Policy Center

Child Policy Briefs, January 2002

• Child Care: Benefits for Low-Income Children
• Child Care: Georgia and the Region
• Child Care: Needs of Working Mothers

Do Enrollees in "Look-Alike" Medicaid and SCHIP Programs Really Look Alike? Jennifer N. Edwards, Janet Bronstein, and David B. Rein, accepted December 2001 for publication in Health Affairs.

Georgia Child Data Report, Patricia Ketsche, July 2001.

Healthcare Services for Rural Georgians, Report of the Georgia Rural Development Council, October 2001.

Improving School Health in Georgia: Results of a Survey of School Superintendents, Jennifer N. Edwards and Jennifer L. Antinozzi, March 2001.

Improving Care at the End-of-Life: A Long-Term Care Initiative, Georgia Collaborative to Improve Care at the End-of-Life, June 2001.

Improving Rural Health: An Issue Paper, The Philanthropic Collaborative for a Healthy Georgia, December 2001.

Kids and Dental Providers in Georgia: The Gap Between Demand and Supply, Kathleen Hoza Lysak, Katherine Gardner, and Jennifer Edwards, May 2001.

Regional Child Care Trends: Comparing Georgia to Its Neighbors, Lauren Waits, Malina Monaco, Lisa Beck, and Jennifer N. Edwards, September 2001.

Rough Passages for Long-Term Care: The Churning Effect”. Long-Term Care Interface, January 2001.

Rural Health in Georgia: "A Framework for Success," Report of the Rural Healthcare Development Council, February 2001.

The Health Care System for Medicaid Children with Special Health Care Needs, S. Nicole Fehrenbach, Jennifer N. Edwards, and Maria McHugh, January 2001.

Update, a newsletter prepared for the Philanthropic Collaborative for a Healthy Georgia, Winter and Summer 2001.