Op-Ed

Mangling North Carolina’s model Medicaid system

Gov. Pat McCrory listens to Secretary of Health and Human Service Rick Brajer, left, prior to signing Medicaid privatization legislation at the Executive Mansion in September.
Gov. Pat McCrory listens to Secretary of Health and Human Service Rick Brajer, left, prior to signing Medicaid privatization legislation at the Executive Mansion in September. Robert Willett rwillett@newsobserver.com

North Carolina’s Medicaid reform proposal ignores some highly pertinent facts and is not in the best interest of our state. The plan as presented to the Centers for Medicare and Medicaid Services seeks approval for dividing the state into three regions, with each having a for-profit managed care organization to compete with local provider-led entities. Such a format would be cumbersome to formulate and would add layers of bureaucratic complexity to the Medicaid system in North Carolina.

This terribly divisive proposal ignores the fact that, contrary to rhetoric from our governor and other politicians describing Medicaid as “broken,” the N.C. Medicaid system is nationally recognized as doing well. It has over 90 percent of primary care physicians across the state participating. These physicians and many specialists are supported by nonprofit Community Care of North Carolina, which is a consortium of 14 nonprofit entities covering all 100 counties.

CCNC began about 20 years ago and has evolved, building grassroots connectivity with health care providers across the entire state. It works with every hospital in N.C., with thousands of private practicing physicians, with every county health department, with all 34 federally qualified health centers and with all 27 rural health centers. CCNC is a model that numerous other states have tried to emulate.

While enrollment growth has generated an increase in total costs, the per capita cost of health care for Medicaid patients in N.C. has gone down since 2010. There was a 4 percent decrease in 2011, and by 2015 a greater than 8 percent reduction as compared with 2010. No Medicaid program in any other state has had such experience. In fact, no commercial insurance company or any MCO can show such results.

More costs, aggravations

What is the logic of disrupting such a successful homegrown system with for-profit MCOs that will cost more and generate aggravations for the provider community?

Notable is that these cost savings under the current system have accrued through improved clinical outcomes for patients, resulting in fewer emergency department visits and fewer hospitalizations.

The inaugural Hearst Health Award in Philadelphia was given to CCNC in March noting its innovative effectiveness in managing and improving the health of a population of patients. This citation was made after assessments of a wide array of programs across our nation.

NC DHHS Secretary Rick Brajer, in striving to implement the reform package as developed by the legislature, has held 12 public hearings across the state. He did an effective job in articulating the message and in listening to comments in sessions that were well-conducted. I attended the hearing in Raleigh and noted that each of about 15 physicians to speak expressed disapproval of the reform plan and spoke in support of CCNC. I am told that such opinions were articulated by all physician speakers in the other 11 hearings. They also voiced serious concerns for having to deal with multiple entities within the Medicaid system to gain reimbursement for services delivered.

At these hearings were repeated pleas for North Carolina to shrink the uninsured population by accepting the federal money that has been allocated to expand Medicaid in our state. To do so would help the economy in every county, especially in the less affluent regions. It would generate jobs and be a huge boost to hospitals and safety net clinics, not to mention dramatically improve the lives of nearly a half million N.C. residents who struggle to gain access to health care.

North Carolina has a model Medicaid system that has a proven track record for decreasing per capita costs that no other state nor any MCO can rival. Rather than scuttle it, pragmatic good sense calls for its expansion. Let’s do what is best for the people of North Carolina.

Robert H. Bilbro, M.D., is a co-founder of the Raleigh Medical Group.

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