The shift to Medicaid-based managed care in North Carolina should happen by 2019.
 
The topic was the focus of a recent meeting in Wilmington hosted by Community Care of the Lower Cape Fear (CCLCF) titled “NC Medicaid Reform: Updates and Strategies.”
 
Speakers from state agencies and health care providers working on the plan provided updates and proposed timelines as managed care comes to the state.
 
Depending on state and federal approvals, Medicaid and N.C. Health Choice programs should shift in 2019 from a predominantly fee-for-service delivery model to managed care, or what CCLCF calls “integrating services to provide whole person, value-based care.”
 
Under the new system, most Medicaid recipients will have to choose from between four to six Medicaid managed care organizations and provider-led plans.
 
According to the state Department of Health and Human Services website, the switch to Medicaid-managed care “is the most significant change to the Medicaid program in over 40 years.”

New Hanover Regional Medical Center spokesman Julian March said the hospital system “is deeply committed to the success of a Medicaid-managed care solution in North Carolina.”
 
He said that along with 10 other hospital systems, NHRMC has partnered with Presbyterian Health of New Mexico “to form a managed care insurance company led by doctors and other health care providers.”
 
The hospitals’ plan, N.C. Provider Owned Plans, will be called “My Health by Health Providers.”
 
March said that the state would soon issue a request for proposals for both statewide and regional plans to be launched in North Carolina, with those plans expected to begin in about 18 months.
 
“These plans will become the administrators of the Medicaid program in North Carolina. We hope that My Health is selected as one of the statewide plans,” he said. “As plan owners, we see this transformation as an opportunity to align payment with proven care delivery models to drive improvement in health outcomes for patients, while reducing costs for taxpayers.”
 
March said NHRMC and other participants will partner with the independent doctors and other health care providers who are aligned with the Community Care Physician Network, that coordinates care for Medicaid patients in this region.
 
He said that as a provider, NHRMC would partner with Community Care of the Lower Cape Fear “in providing provider-based care management services for its Medicaid patients.”
 
The move by the state to a Medicaid managed care model is another example of the health care industry’s rapid changes, said Wilmington Health CEO Jeff James.
 
He said that the current managed care model in North Carolina dates back to the early 1970s and prompted the health maintenance organization movement.
 
“Its design was intended to ‘manage’ a patient’s access to care while controlling costs, but eventually led to less focus on the quality of care being delivered or the patient’s health outcome,” James said.
 
“We believe that a value-based managed care model, one that Wilmington Health is actively embracing, will drive more dramatic change to the entire health care system moving forward,” he added.
 
He said value-based care “demonstrates that both higher quality and lower cost can be achieved simultaneously. The individual patient will see improvements to physical and financial health and in turn drive waste out of the health care system.”
 
James said he supports DHHS’ efforts to modernize Medicaid-based care but sees a need for additional changes to help make a new program effective for patients.
 
“I believe that there is merit to what the state is attempting. I hope that their embracing of change continues to move toward providing great health care value to the patients in our state and community, who are dependent upon this vital program,” he said.
 
“However, value-based health care will continue to underperform in North Carolina without changes in other areas as well. Improved transparency and meaningful reform to the antiquated Certificate of Need laws in the state are two examples.”
 
Novant Health, which operates Novant Health Brunswick Medical Center, is one of the health care systems partnering with Presbyterian Health of New Mexico in forming the managed care insurance company.
 
It and the other health care providers formed N.C. Provider Owned Plans within the framework of the partnership with Presbyterian Health.
 
“As mission-based North Carolina- located health systems and owners of North Carolina Provider Owned Plans, Inc., we believe that providers should be part of the solution and whether it is our health systems or our health plan, we will remain committed to our communities,” a news release from Novant release stated.
 
As the provider-owned and -led plan is developed, “we will partner regionally to improve care in our communities and statewide to provide a single statewide network of providers, ensuring our members have access to care when and where it is needed,” the stated.
 
Randy Barrington, director of provider services for CCLCF, said those at the recent meeting in Wilmington asked many questions and requested additional information.
 
“We want our independent practices to understand how CCPN, a physician-led, clinically integrated network, can help them prepare and thrive as North Carolina Medicaid transforms,” Barrington said.
 
CCLCF works with the state organization, Community Care of North Carolina, which serves 1.7 million Medicaid and dually eligible recipients in the state.
 
The Department of Health and Human Services’ aim for managed care is to “improve population health, engage and support providers, and establish a sustainable program with more predictable costs,” CCLCF spokeswoman Sarah Ridout added.
 
She said CCNC’s goal is to support the transformation.
 
“Managed care organizations are very interested in CCNC’s infrastructure: community-based roots, care manager ‘boots on the ground’ in all 100 counties, targeted clinical interventions with a documented return-on-investment and long-standing relationships with physicians,” Ridout said.

Editor's note: This version updates spokesman Julian March as the source for New Hanover Regional Medical Center's information.