Health care providers support Medicaid changes that stop short of managed care

lbonner@newsobserver.comJanuary 15, 2014 

State hospitals, doctors and pharmacies united Wednesday in support of Medicaid changes that stop short of full managed care but would reward them for quality, cost-conscious care.

An advisory committee on state Medicaid changes heard from nearly 50 speakers Wednesday as it gathered more information on potential changes to the government health insurance program for low-income children and their parents, the elderly and disabled.

Gov. Pat McCrory’s administration wants to control Medicaid spending with a switch to managed care. Medicaid spending has dented the budget in recent years. Some of the overruns were due to inaccurate budget forecasts. Under managed care, providers would be given a set amount to treat patients and would be responsible for costs if they overspend.

Managed care would represent a major switch from the current system where doctors, hospitals and other health care providers are paid for each procedure.

Most say Medicaid can improve, but there’s no agreement how to do it.

The message from doctors’ groups, hospitals and retail pharmacies is that they support change but don’t want full managed care.

What they’ve proposed is a type of health care and payment system that can be run by providers. These “accountable care organizations” would be responsible for reaching health care goals and controlling costs. They would share in any cost savings. National managed care insurance companies would not necessarily be involved.

“Reform must keep scarce health care dollars in North Carolina, providing the care our patients need, not paying for additional administrative overhead that is funneled to multiple out-of-state companies,” said Dr. Bill Dennis, president of the N.C. Academy of Family Physicians. “We simply cannot afford to settle for the failed policies of managed care that have proven to be disastrous in state after state throughout our country.”

The federal Affordable Care Act encourages providers to set up accountable care organizations for Medicare, the government insurance program for the elderly. More than 20 are operating in the state.

Several speakers said affordable care organizations could build upon the statewide patient-care management program Community Care of North Carolina. CCNC has Medicaid patients choose a “medical home” that oversees their care. Patients with chronic illnesses get extra looking-after.

Last year, Dr. Aldona Wos, the state’s health and human services chief, floated the idea of having three or more statewide managed care organizations run Medicaid. One of the goals is to better integrate physical, mental and dental health, which the administration says would be easier under managed care. The proposal for statewide networks was roundly criticized.

A department consultant presented a modified proposal last month that would divide the state into regions where managed care organizations would operate.

The administration is set to get its recommendations to the legislature in March and wants lawmakers to approve a plan DHHS can pursue. The federal government must also approve any significant change to Medicaid.

A majority of other states have a least some Medicaid patients in managed care, and a few speakers on Wednesday said managed care works.

Mark Trail, the former Georgia Medicaid director who is a consultant working for the insurance company WellPoint, said Medicaid managed care for children and families has saved Georgia $4.3 billion in the last five years.

North Carolina’s Medicaid program enrolls about 1.7 million people and costs about $13 billion. About $3.5 billion comes from state coffers, with the federal government paying the rest.

Much of the discussion Wednesday was about money and control of medical care, but Matthew Potter of Pfafftown came to remind policymakers that the policies are really about people.

“The time is over for treating lives as nothing more than a series of numbers,” said Potter, a Medicaid recipient who has cerebral palsy.

“It’s time to stop thinking of it that way and think of it in terms of lives of people that often get lost in policies and budgets.”

Bonner: 919-829-4821; Twitter: @Lynn_Bonner

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