Holly Biola: Medicaid reform that helps only profits

I read the Sept. 22 news article “NC legislature approves Medicaid privatization” with trepidation and dismay. As a family doctor at a busy urban community health center, I often feel it is all I can do to care for each patient I see that day. “Population medicine” – thinking about our center’s care of our entire community – is important work, but it is hard to fit into a day filled with direct patient care. Community Care of North Carolina has been my partner – the partner of so many of us primary care doctors – in caring for our Medicaid patient population and in improving our care overall.

CCNC helps me to:

1. Keep up with evidence-based guidelines. It lets me know when my patients with asthma, diabetes, heart conditions or strokes are not filling medications. It also lets me know how I am doing compared with other practices on these measures. CCNC even arranges get-togethers of doctors to go over these things.

2. Give the right care at the right time. It lets me know when my patients are showing up at the Emergency Department during business hours with non-urgent problems. It helps patients understand the system and how best to access the most appropriate care.

3. Wrap appropriate services around my most complex patients. For patients with multiple or severe problems that have landed them in the hospital, CCNC will visit them – often at home – and make sure they are able to get medicines and can safely get around their home.

4. Have vital information. CCNC has created a “Provider Portal” through which I can see the names and numbers of my patients’ other doctors or therapists so that we can more easily coordinate care. I can even see the names of the medicines they are fillingand the dates they picked it up from which pharmacy.

5. Have direct communication. My local CCNC network’s staff has taken the extra (and arduous) steps to become integrated into my system so that they can send me messages about our shared patients directly in that person’s electronic medical record.

6. Build relationships around the primary care office. I recently had a patient whose kidneys had taken a turn for the worse. Through a quick phone call to CCNC’s Community Pharmacist program, I was able to find out that another doctor had started giving him a medicine around the time he started to have problems. Also I had a patient who needed assistance getting appropriate behavioral health care. At my CCNC network meeting, I ran into exactly the person who could help.

The systems and relationships used to achieve all of these successes took years to build. It’s an organization for which quality is the goal, not profit. It is hard to understand the goal of this “patient-centered” Medicaid reform. How does disrupting these relationships help patients? How does allowing private companies to carve profit out of our tax dollars help North Carolina as a whole?

In my 15 years of practice, I have seen private insurance companies make more and more money by giving less care to patients and less money to doctors.My hope is that the federal government will deny our legislature’s request for a waiver to privatize N.C. Medicaid, so that CCNC can continue the good work it’s doing now.

The length limit was waived to permit a fuller response to the issue.

This story was originally published September 26, 2015 at 1:02 PM with the headline "Holly Biola: Medicaid reform that helps only profits."