Wos: New Medicaid plan meant to build on – not undo – gains in N.C. care

By admin
In Government Efficiency
Apr 16th, 2013

RALEIGH — For the first time, we have a comprehensive vision for a sustainable Medicaid system in North Carolina. The “Partnership for a Healthy North Carolina” that Gov. Pat McCrory and I announced last week is a bold framework to improve mental and physical health care and outcomes for North Carolina’s most vulnerable citizens.

But a common question about the plan – especially among the N.C. provider community – has been, “Why do we need yet another plan to fix the Medicaid system here in North Carolina?” So I’d like to answer that question head-on and share with you some reasons this plan is the next logical and essential evolution to create a healthier North Carolina.

This reform plan seeks to build on – not undo – the significant gains and innovations in community-based care in our state and take them to the next level. That’s why we began this reform process by going to the people who know North Carolina’s system best: our recipients, providers and health care advocacy groups. We asked everyone to come to the table with their ideas for reform. We received more than 160 responses.

The responses shared many common concerns, including a disjointed IT system and too much administrative duplication. But there was also agreement that our Medicaid system did not look at a person as a whole, separating physical health and mental health and even substance abuse into different silos of care that didn’t collaborate to improve patient outcomes. In our current system it is often difficult for Medicaid recipients to know where to go to get the services they need.

We used those responses to develop our framework, which will create a comprehensive system to coordinate a network of care around the whole person. The central piece of the “Partnership for a Healthy North Carolina” is the formation of approximately three “Comprehensive Care Entities.” These entities will be responsible for coordinating physical and behavioral health care for all Medicaid recipients. They will build or partner with existing providers or networks to ensure each individual will receive the right care at the right place and at the right time based upon their needs.

Our plan also takes into account important lessons learned, good and bad, from managed and community care reform in other states. As a physician, I lived through a difficult implementation of a system of managed care in New York during the 1980s. In fact, it was so “well-managed” that it managed many physicians right out of business! With our plan, we want to make North Carolina the best place to practice medicine in the country.

In the past, our state used a piecemeal approach to reform, but cutting services for short-term savings only yields short-term results. This effort is not a budget exercise. This effort is bold action to ensure our costs are more predictable and sustainable in the long-term.

We invite everyone to join us in this exciting effort to create a Medicaid system that cares for the whole person, increases preventive care and reduces the need for more expensive, inefficient emergency care. We need creative and innovative ideas from the public and private sectors to make this vision a reality. In the coming weeks, we will be holding “office hours” for anyone who would like to find out more and provide feedback.

We know this change may be difficult for some. I firmly believe that this partnership can build a sustainable Medicaid system that creates a healthier North Carolina.