No managed care for Medicaid

As we await any forthcoming Medicaid reform legislation, the North Carolina Medical Society wants to clearly state what the doctors and hospitals, nursing homes and behavioral health providers know is the clear path forward to save the state money and provide the highest quality care.

Our Medicaid reform plan, created with other health care organizations representing Medicaid beneficiaries and presented to legislators several weeks ago, places a patient’s care at the center. Doctors would be assessed not on the number of patients they see, but on the quality and value of care they provide. This is the central tenet of our plan – care for the patient. And healthier patients mean less cost over time. This may not be a quick fix, but it’s the right choice for the health of the pregnant women, children, aged, blind and disabled North Carolinians who receive Medicaid benefits.

Those in the health care community who painstakingly devised this plan appreciate the state’s desire for budget predictability and have agreed to assume the risk if the cost savings do not materialize. This new approach to health care reimbursement over the old fee-for-service model, in which doctors were rewarded for the number of procedures they performed, is a daunting leap forward for doctors and others in the health care community, but we are up to the challenge.

The fact health care providers are willing to assume risk for their patients’ care is a testament to their desire not to return to the disproven corporate managed care model some believe is the easy solution to cost predictability for the state. The doctors also are confident if they truly are in charge of their patients’ care – not subject to a corporate entity’s accountants – the savings will accrue. Taxpayers will further benefit because profits will not go to out-of-state insurers, but back into the state’s Medicaid coffers.

Importing managed care into North Carolina may prove extremely costly in the short run, as well as over the long haul. It would require dismantling the care coordination system we have in place driving up costs and setting a higher cost benchmark when negotiating the contracts with these companies.

With the current turmoil in our health care system and growing Medicaid rolls in many states, bringing in managed care organizations to run the Medicaid program here can be an enticing alternative to lawmakers struggling with how to allocate limited resources.

In North Carolina, however, we are lucky to have a care coordination infrastructure already in place to help support a homegrown Medicaid reform solution. And we have a highly engaged, hard-working health care community, willing to come together to advocate the best care for Medicaid beneficiaries and even to stake their own financial certainty on a new model of care delivery and reimbursement.

We hope in the coming weeks legislators will take the long view, beyond their political tenure, to ensure the future financial health of the state and to allow health care providers to do the right thing for the most vulnerable residents of North Carolina.

This story was originally published June 5, 2015 at 5:30 PM with the headline "No managed care for Medicaid."