State officials pitch Medicaid managed care to doctors May 16, 2013 

— The McCrory administration’s plan to convert the $13 billion Medicaid program to managed care remains an outline as two top health officials travel the state pitching it to doctors and other health care providers.

Dr. Aldona Wos, head of the state Department of Health and Human Services, told a crowd of doctors and other health care providers that she wanted them to help figure out the next steps. The aim is to integrate physical, mental and dental health and make costs predictable for the state.

In a national address earlier this month, Gov. Pat McCrory called on President Barack Obama to approve the state’s Medicaid request, but it’s clear that the state’s doctors and other health care professionals aren’t convinced that managed care is the best course. The proposal needs to be approved by the federal government and state legislature.

Mentions of Community Care of North Carolina, which currently works with Medicaid patients in the state, during the question and answer session Wednesday triggered loud applause from the crowd of more than 200.

The McCrory administration plan calls for three or four statewide managed care organizations to offer health insurance plans to the state’s 1.5 million Medicaid patients and children in the subsidized health insurance program.

CCNC is a network of doctors that seeks to lower Medicaid costs with timely treatment that keeps patients out of emergency rooms and by monitoring patients with chronic diseases such as asthma. CCNC would not continue in its current form, but DHHS officials have said it would be able to bid to become one of the managed care entities offering health care plans.

“Why do we think this will improve the system over what we already have, Community Care North Carolina, when they’re integrating mental health within the medical home within their networks?” asked Dr. Genie Komives, a family doctor in Hillsborough.

Doctors’ organizations and hospitals have a clear preference for keeping CCNC. When DHHS asked the public earlier this year for ideas on changing Medicaid, doctors’ groups and the N.C. Hospital Association suggested the state make the CCNC network more robust by incorporating mental health, adding medical specialists and drawing hospitals into the loop.

Health care providers are wary of managed care because the companies agree to take care of patients’ health needs for a set price and take the losses if they spend more. But companies pass at least some of the financial risk on to doctors, hospitals and other health care providers. DHHS officials said they do not know how they would have companies and providers share the financial risk, but they were researching other states’ approaches to see what works and learn what not to do.

“We certainly never want to repeat mistakes of the past that any other state has made,” Wos said.

Medicaid director Carol Steckel called CCNC a baseline the state would build on but criticized it for not incorporating mental health care in its networks throughout the state.

“Every community that we’ve been to, including this one, everyone recognizes the system needs to go to the next level – that there are significant gaps in the system,” she said.

Blame on expansion denial

As she was at a similar forum in Reidsville last week, Wos was criticized for not speaking out when the legislature and McCrory decided not to expand Medicaid to include 500,000 working class residents.

In Reidsville, Wos wrongly put the responsibility for not expanding Medicaid on state Insurance Commissioner Wayne Goodwin.

Wos and Steckel had a new response Wednesday. Steckel cut off the first doctor, Dr. Ada Adimora, a professor of medicine at UNC-Chapel Hill, who talked about the decision not to expand Medicaid. Adimora called the decision “bad from a public health standpoint.”

“We hear your opinion about the Medicaid expansion,” Steckel said. “Let’s talk about how we can improve the existing Medicaid program.”

Dr. Charles van der Horst of UNC challenged Wos to use her office as a bully pulpit and stand up when legislators and McCrory “start saying things that are nutty.”

Among the “nutty” things van der Horst named were reversals in initiatives that reduce smoking, requiring minors to have notarized permission to receive mental health treatment, and reducing taxes on wealthy people while having poor people pay more.

“I’m a one percenter,” van der Horst said. “They want to cut my taxes by 50 percent and start taxing medications, and physician visits, and food for God’s sake. That’s nutty.”

Wos had little to say about that suggestion.

“Thank you for sharing,” Wos told van der Horst.

Asked about it after the meeting, she shrugged.

Bonner: 919-829-4821

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