Caresource Georgia Co

Programs: Caresource georgia ("csga") is a nonprofit corporation established under the state laws of georgia. On july 18, 2017, csga received a determination letter from the internal revenue service, recognizing csga as an organization exempt from federal income tax under section 501(c)(3) of the internal revenue code, effective as of the date of csga's formation. Csga is a member of the caresource group of nonprofit organizations (the "caresource group"). The parent of the caresource group is caresource management group co ("csmg"), an ohio nonprofit corporation that is tax-exempt under section 501(c)(3) of the internal revenue code of 1986 (the "code"). The caresource group's primary activity for the last twenty-eight (28) years has been to provide nonprofit medicaid health maintenance organization ("hmo") services. The mission of the caresource group is to make a lasting difference in its members' lives by improving their health and well-being. The caresource group firmly adheres to this mission, which it terms as the organization's "heartbeat," by providing services that go beyond the delivery of medical benefits. Csga began providing care to participants in its medicaid hmo plan on july 1, 2017. As a medicaid-only hmo, csga exclusively serves individuals meeting the low-income thresholds for medicaid eligibility. Csga participates in the state of georgia's planning 4 healthy babies program, or p4hb, which is a demonstration waiver program for women meeting medicaid income thresholds designed to help reduce the number of low birth weight babies born each year. Through the p4hb program, csga offers family planning services, healthcare coverage for certain pregnancy related chronic conditions, and case management services to women at risk for a low birth weight delivery. In accordance with the caresource group's charitable mission, csga provides numerous programs and policies that encourage its members to obtain preventative and necessary medical care. Many of these programs are educational in nature and intended to make each member aware of their benefits. For example, upon enrollment, each member receives a handbook with an overall explanation of benefits. Members also receive periodic newsletters which include additional information on member benefits and reminders concerning preventative care. Additionally, csga contacts members throughout the year to further assist members in understanding their benefits. As part of the year in the life project, csga will rely on data and analytical models assembled by the caresource group intended to maximize the effectiveness of a communication by tailoring its timing and method to the individual member. Finally, upon enrollment, each member will be automatically assigned both a primary care physician ("pcp") and primary dental provider ("pdp"). Assigning a pcp represents the first step in encouraging members to utilize their benefits. Also, because each pcp will be required to contact members to schedule early and periodic screening, diagnostic, and treatment ("epsdt") appointments for children covered by csga, it increases the likelihood that csga's youngest members receive the preventative care they need. Ensuring members have access to quality dental care is also essential, as dental care is closely linked to the overall health and well-being of members. Csga implements other programs and policies to improve its members' overall well-being. For example, csga offers a rewards for wellness program where members can earn rewards each year by doing healthy activities. These rewards can be used to buy items through select stores or online sites. Wellness rewards are available for kids, adults, and pregnant moms and babies. Csga provides dental and vision benefits to all members, including those over the age of twenty-one (21). Additionally, csga provides members with free access to a nursing hotline twenty-four (24) hours a day, seven (7) days a week. These nurses review a member's symptoms, offer guidance on when to seek medical care, explain any conditions a member has been recently diagnosed, provide education on over-the-counter medications, and help members prepare a list of questions prior to a visit with their doctor. This triaging of care both improves the efficiency of the medicaid program and reduces unnecessary hospitalizations and emergency department visits. Csga aims to remove poverty as a barrier to achieving good health, and csga provides a number of programs designed to meet challenges that are specific to individuals with low-incomes. One program is transportation. Because low-income individuals frequently have difficulty keeping medical appointments due to a lack of transportation, csga will augment their transportation benefit. Csga provides enhanced benefits to members that are above and beyond required benefits defined by state or federal agencies. Together, these enhanced benefits provide csga members additional program benefits in order to make a lasting difference in members' lives by improving their health and well-being. In 2017, csga paid over $800 thousand to fund these enhanced member benefits. In 2016, the caresource group implemented caresource life services, a program focused on helping members get and keep jobs they need to improve their lives. Life services offers services and support that can pave the way from where members are to where they want to be. Life services offers tools to help members balance work and life and to remove barriers that stand in the way of reaching their dreams. Csga can help with employment assistance, free ged testing, interview skills, reliable childcare, dependable transportation, budgeting and personal finance, job training, and stress management. In addition, csga initiated arrangements with fifth third bank for free or reduced banking services for members. Each participant is assigned a life coach, who helps them build a personal plan for success, and the pilot program has already worked with over 500 members successfully employing more than 30 individuals. Csga has built a network of more than 70 potential employers and community resources to partner in job placement for members. Csga partnered with chattahoochee technical college to provide financial support and jobconnect services to students enrolled in the school's special population services. Students in special populations services may be classified as economically disadvantaged because they receive assistance from safety net programs, pregnant students or young mothers, or nontraditional students. This partnership provided scholarship opportunities and financial resources to students in the high demand education programs. This partnership includes an annual job fair, onsite marketing, onsite coaching for caresource members and students, and career development services. Over 80% of the georgia medicaid population is children. As a result, it was imperative that csga develop arrangements that address the health status and social needs of this population. Therefore, csga offers membership to local girls & boys clubs, ymcas and girl scouts of america to encourage additional civic and community engagement in georgia's youth members. Csga is also implementing a childhood obesity management program, designed to help children between the ages of five (5) and seventeen (17) lose weight. Importantly, csga operates under the caresource group's unique care coordination models. The primary model is care4u. Care4u represents an innovative and patient-centered approach to health care, as it focuses resources on improving and maintaining overall population health. Care4u does this through a new digital platform to assist in the management of chronic conditions. As part of care4u, csga undertakes extensive efforts to help educate its members, including providing each individual with a customized wellness plan. Csga uses care transitions, a program specifically tailored to coordinate care as members transfer between different levels of care and different settings, such as between home care and hospital care. In conjunction with care4u and care transitions, csga relies on outcomesmtm to coordinate its members' medication usage. Csga's outcomesmtm will collect data on all medications that a member is currently taking. Csga runs this data through several clinical algorithms to identify possible issues related to cost, safety, and over-utilization. Any issues that are identified are shared with pharmacists, who then provide members with face-to-face counseling. This individualized review of each member's medication usage has been instrumental in improving member health, as evidenced by a reduced number of hospitalizations and emergency department visits. In 2013, the caresource group was awarded the ohio association of health plans' pinnacle award for best practices for its implementation of outcomesmtm. Csga, along with other members of the caresource group, are still among the few medicaid ma