Georgia Health Advantage (GHA) is an Institutional Medicare Advantage Special Needs Plan (ISNP) HMO available to Medicare beneficiaries since 2020 who live in participating long-term care communities for 90 days or longer, primarily CHSGa nursing facilities. Specialized for long-term care residents, Georgia Health Advantage offers members personalized care from a dedicated clinical team that includes on-site advanced practice providers (APPs)—a nurse practitioner or physician assistant serving as the front line of primary care—and a registered nurse care manager. GHA Choice is an Institutional Equivalent Special Needs Plan (IESNP) that has served members since 2021 who meet a nursing facility level of care but reside in the community, providing care at home by APPs as well as an RN case manager (RNCM). The plans are licensed to serve 115 counties of the state for eligible beneficiaries with Medicare Parts A and B; for June 2023, GHA’s census was 1,233 while GHA Choice had 96 members.

As a Part C Medicare special needs plan, GHA and GHA Choice provide Medicare Part A, Part B and Part D services as well as specialized supplemental benefits geared toward long-term care populations. GHA is clinically integrated with primary care and nursing center services while GHA Choice collaborates closely with community primary care physicians and with NextStep Care, CHSGa’s care management provider for members of Georgia’s home- and community-based Elderly and Disabled Medicaid waiver. The ISNP and the IESNP primarily serve a dually eligible population both in the nursing centers and in the community.

GHA and GHA Choice goals include a proactive, patient-centered approach to care delivery and improving outcomes for members. The plan works to achieve clinical goals in several key ways, including by preventing or identifying early on changes of condition and exacerbations of chronic conditions. Treating members in place as possible to avoid preventable hospitalizations, facilitating access to specialty care and advance care planning are also important facets of the plan’s model. GHA for 2023 earned an overall rating of 4.5 out of 5 stars from CMS.

In addition to Ethica and NSC, key partners for GHA and GHA Choice include:

• TruHealth—the contracted clinical team that delivers the model of care to people enrolled in Georgia Health Advantage; TruHealth clinicians include nurse practitioners, physician assistants and registered nurse case managers
• AssureSource—a field marketing organization with a SNP focus licensed in 23 states, responsible for marketing and enrollment
• Nations—the provider of over-the-counter and grocery card supplemental benefits for GHA, with a focus on benefits that address social drivers of care and improve member satisfaction with health plans 

Supplemental benefits for GHA include up to 79 hours per year of support assistance by an aide, hearing aid and vision benefits and up to six podiatry visits per year.


GHA Choice Supplemental benefits include hearing and vision benefits as well as a food card benefit of $280 per quarter for healthy groceries and OTC benefit of $300 per calendar quarter for OTC health and wellness products. Key Components of the GHA and GHA Choice Model of Care: 

• Health Risk Assessment (HRA) screening tool addressing areas of increased risk (recent hospitalizations, comorbidities, falls, etc.) as well as medical, functional, cognitive, psychosocial and mental health areas
• Individualized Care Team—APPs and RNCM attend regularly scheduled care planning meetings alongside nursing center staff; GHA staff also meets internally with other members of the interdisciplinary care team (ICT) include the  market Medical Director and Clinical Program Manager, APPs, RNCMs, Pharmacy Director and Utilization Management (UM) staff who meet weekly to discuss members experiencing, or at risk of experiencing, a care transition.
  
  º Additionally, for GHA Choice, TruHealth clinical staff and GHA plan associates attend weekly care team meetings with NextStep Care to coordinate care, as well as quarterly operations calls to review all aspects of IESNP activity to ensure optimal member health and satisfaction with the plan
  
  • Individual Care Plan (ICP)—based on the HRA and updated regularly based on medical or pharmacy claims, changes in member status, etc. Includes member’s self-management goals and objectives, personal healthcare preferences and
  a description of services specifically tailored to the member’s needs