State Rep. Donny Lambeth: No managed care for Medicaid

May 20, 2013 

No managed care for Medicaid

As a member of the N.C. House, I applaud the focus of the McCrory administration on making state government more efficient. Reforming government programs is essential.

As a former hospital administrator, I know one of the largest programs needing reform is Medicaid. The $13 billion Medicaid program serves 1.5 million adults and children, some of the most disadvantaged in our state.

I am not convinced that having for-profit managed-care companies deliver medical, mental and dental care is the most effective approach to reforming Medicaid. When all we have is a sketchy outline proposed by the secretary of Health and Human Services, I advocate a cautious and deliberate approach to studying options.

The state should take advantage of the current model, Community Care of North Carolina. This model is patient-centered and has saved taxpayers hundreds of millions of dollars over the past several years by providing patients a medical home and coordinating their care built on “experience-based” medicine. CCNC should be expanded across the state to coordinate care for all Medicaid patients.

Other states are moving away from for-profit managed-care companies toward the CCNC model, so why does North Carolina want to move in the opposite direction? CCNC recently was recognized by Sen. Richard Burr with the Wellness Frontiers Award.

A key piece of the financial picture for Medicaid should be restructuring the reimbursement system that is outcome-based, using key quality metrics to reward or penalize providers. The state must create an environment between physicians and hospitals that aligns incentives and rewards the best clinical practices.

The McCrory administration has been targeting the onerous regulations that bog down business and unnecessarily drive up costs. The health care industry perhaps is the most heavily regulated industry. Medicaid reform must reduce the regulatory burden on care providers so they can focus on patient quality and safety rather than on enormous administrative burdens.

Finally, North Carolina’s Medicaid system must emphasize developing a new culture, based on wellness and fitness, prevention and healthy lifestyles.

Our state is fortunate to have outstanding hospitals and physicians. Let’s take advantage of our strengths and build on them to enhance our Medicaid program instead of moving down a path that will result in disastrous consequences for our most vulnerable citizens.

Rep. Donny Lambeth

Winston-Salem

The writer, a Republican, represents N.C. District 75. The length limit was waived to allow a full commentary.

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