New NC Medicaid managed care company formed by state doctors

The state’s professional organization for doctors, once an ardent opponent of Medicaid managed care, is forming a managed-care company to compete for a contract to provide medical care to low-income residents statewide.

In managed care, private companies oversee patient care. The state has asked the federal government for permission to move to a managed-care system for Medicaid, the government health insurance program that covers about 1.8 million people in North Carolina, including low-income children and some of their parents, the elderly and the disabled.

The N.C. Medical Society on Tuesday announced a partnership with Centene Corp., a national managed-care company, and the N.C. Community Health Center Association. The new company, Carolina Complete Health, would seek to offer health-care plans to Medicaid patients when the state changes the way it pays providers for patient care.

The state wants to enter into contracts with companies that would offer statewide health insurance plans for Medicaid recipients. The state also proposes to have contracts with networks of doctors and hospitals that would offer regional plans. The idea is that Medicaid patients would have a choice of health-care plans.

Under the proposal, the state would no longer pay health-care providers for each medical procedure or visit, but would give the health plans a set amount of money for each patient enrolled. The health-care companies would be responsible for cost overruns.

Carolina Complete Health wants to compete for one of the three statewide managed-care contracts, Medical Society CEO Robert Seligson said in a meeting with News & Observer editorial writers.

“We fought managed care for a long time,” Seligson said. When managed care became part of the law “we felt that if we sat on the sidelines and didn’t position ourselves, being physicians, to have a say-so in how health care is delivered, that we’d be doing the patients of this state a great disservice.”

The Carolina Complete Health Network would be jointly owned by the Medical Society, doctors, physician assistants, nurse practitioners, and Federally Qualified Health Centers – 38 organizations with 200 clinics.

Centene has Medicaid contracts in 18 states. Executive Vice President Brent Layton said its partnership with the Medical Society and the community health centers is unique.

Penella M. Washington, CEO of Advance Community Health, said the community health centers are looking for partnerships that will help them provide cost-efficient, quality care. Advance has offices in Wake and Franklin counties.

The arrangement with the Medical Society connects them to “a full spectrum of providers,” and Centene brings case management and sophisticated analytics, Washington said.

The state asked the federal government to switch its Medicaid program to managed care last year. The transition is expected to take several years.

This story was originally published January 10, 2017 at 12:00 PM with the headline "New NC Medicaid managed care company formed by state doctors."