Recent Data Shows Value-Based Care Improves Health Outcomes in Georgia

Staff Report

Wednesday, July 12th, 2023

CareSource, one of Georgia’s Medicaid Managed Plans that serves more than a half million Georgians, today released new data showing the impact of its Value-Based Care programs, which incentivize health care providers to value quality of care over the number of patients treated. The data reveals a remarkable improvement in year-over-year health outcomes for Value-Based Care members across the state, which in turn reduces or eliminates out-of-pocket expenses and mitigates Medicaid program expenditures for the state. More than 80% of CareSource members now receive their care from providers with Value-Based Care provider agreements.  

“At CareSource, the Value-Based Care approach aligns payer, provider and member actions to achieve and reward higher quality health outcomes,” said Jason Bearden, president of CareSource Georgia. “Preventative care visits are on the rise while emergent and curative care rates decline. We can now say unequivocally that the CareSource VBC model helps to keep our members healthier and our providers happier while also lowering costs.”  

CareSource has achieved notable success in six key focus measures established by the Georgia Department of Community Health, with significant health gains in 2022 compared to 2021: 

·  Breast cancer screenings (+3.4%) 

·  Controlling blood pressure (+ 8.6%) 

·  Childhood immunizations (+6.7%) 

·  Prenatal care (+3.3%) 

·  Postpartum care (+8.8%) 

·  Blood glucose level control (+11.5%)  

These measurements are significant because an increased number of wellness checks, completions of vaccination schedules, first-year-of-life monitoring and other preventative health care visits can thwart many illnesses and help diagnose more serious diseases at earlier stages. In fact, CareSource members served through a Value-Based Care program had 16% fewer emergency room visits, 38% fewer hospital admissions and a 5% lower hospital readmission rate. 

CareSource offers nine unique VBC programs to CareSource providers in order to best accommodate the health care they extend to CareSource members.  Last year, CareSource awarded more than $8.5 million in incentives to health care providers achieving high-performing quality outcomes – which represents a 300% increase over 2021. As a result, twice as many members are seeing primary care physicians each year, the amount of VBC incentive payments to health care providers nearly doubled, and well child visits increased nearly 44% while preventative dental visits increased 10%. 

Better health outcomes mean economic benefits to the state as well. Overall costs for members participating in a VBC program were 28% lower per member/per month than those who did not participate in a VBC program.  

CareSource Value-Based Care programs represent a reimbursement model that rewards health care providers for the delivery of high-quality care and promoting the health and well-being of CareSource members.  Through these programs, CareSource remains committed to driving better health outcomes, enhancing member satisfaction and reducing costs for both members and the state as a whole.