Providers fret over N.C.’s move to Med­i­caid man­aged care

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

North Carolina hos­pi­tals and doc­tors say the state’s push to in­sti­tute Med­i­caid man­aged care will re­duce ser­vices for the poor and short­change providers de­spite the leg­is­la­tion giv­ing them the op­por­tu­nity to bid on the con­tracts.

Late last month, Repub­li­can Gov. Pat McCrory signed leg­is­la­tion en­abling changes that will move the state’s $12.7 bil­lion Med­i­caid pro­gram serv­ing 1.9 mil­lion res­i­dents from fee-for-ser­vice pay­ments made di­rectly to providers to capped pay­ments to man­aged-care in­sur­ers. The state must get CMS ap­proval be­fore mak­ing the change.

The leg­is­la­tion al­lows the state to award three statewide man­aged­care con­tracts to in­sur­ers. It also au­tho­rizes the cre­ation of as many as 12 re­gional “provider-led” en­ti­ties—physi­cians and hos­pi­tals in a Med­i­caid ac­count­able care or­ga­ni­za­tion, for in­stance—that can sign agree­ments with the state to man­age Med­i­caid pop­u­la­tions.

“Un­der the cur­rent sys­tem, we wait un­til peo­ple get sick to pro­vide care and pay for tests— not out­comes,” McCrory said.

Providers backed chang­ing the pro­gram, but re­jected turn­ing to pri­vate in­sur­ers as the main ve­hi­cle for cost con­trol. “We’re con­cerned about the dra­co­nian ways (that plans) try to con­trol things,” said Robert Selig­son, CEO of the North Carolina Med­i­cal So­ci­ety. “In­stead of a value-based medicine ap­proach, they fo­cus on fi­nan­cial re­turns. Wall Street is what drives them.”

“It’s not what we wanted,” said Julie Henry, a spokes­woman for the North Carolina Hos­pi­tal As­so­ci­a­tion. “We wanted an ex­clu­sively provider-led sys­tem, be­cause from our per­spec­tive hos­pi­tals are al­ready bear­ing the fi­nan­cial risk for Med­i­caid pa­tients.”

The state plans to sub­mit its waiver ap­pli­ca­tion to the CMS by next sum­mer.

North Carolina Gov. Pat McCrory

signs Med­i­caid re­form leg­is­la­tion.

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