Members of the General Assembly’s Health and Human Services committee are scheduled to meet today in Raleigh. One of the biggest tasks the committee faces is reforming Medicaid- the program that provides health care for people in poverty.
Earlier this year, state officials seemed to be advocating for a move to managed care. But a new proposal recently put forth by state health officials would build on the state’s current system of treating Medicaid patients.
When the department’s plan came out last week, most of the members of the advisory board overseeing it said they approved.
"Each one of us was asked to write a letter, and I guess I was the one who was not as much in support of the plan as some of the members were," says Republican state senator Louis Pate of Mount Olive.
A key part of the proposal takes as its inspiration an existing network of Medicaid providers, known as Community Care of North Carolina. It has received national accolades for delivering high quality health care. Currently, patients can choose their general practitioners- and that would continue under the proposal.
Senator Pate admires what CCNC does- but he’d actually like to see more coordinated care when it comes to treating Medicaid patients:
"Another thing that I think is important is to have a whole person in the Medicaid arena, treat them both for behavioral problems and physical problems, because someone who comes in to see a medical doctor and gets treated for a medical problem might very well have a mental problem as well and vice versa."
Pate says the goal of a new Medicaid plan should be to treat the whole person.
That’s what the General Assembly specifically asked for in its budget last year.
In an ideal world...
Right now, physical and behavioral health issues are dealt with in separate networks for Medicaid patients, for the most part. In the new proposal, there’s an expectation that the two will work together.
Melanie Phelps is the associate executive director of the North Carolina Medical Society, which represents doctors across the state. She agrees that in an ideal world, physical and behavioral health care for Medicaid patients should be linked. But merging those two systems will take time.
"It takes a whole culture shift in the way medicine is practiced and delivered, so having these the behavioral health and the long term care supports maybe phased in at a later date is not necessarily a bad thing," says Phelps.
Long term care for the elderly and disabled is also handled separately. But under the reform proposal, primary care, specialists and other providers would be required to work more closely together to coordinate and improve care. Phelps says those health care providers would need time to get used to a new way of providing care.
'They're going to have to rethink and relearn how they practice.' - Melanie Phelps
"They’re going to have to rethink and relearn how they practice," says Phelps. "Then you have to put all these new supports in place, you’ve got to be able to do certain data analytics, you’ve got to understand your populations. And it’s very expensive and it’s very time consuming."
Under the proposed plan, Medicaid health care providers would have to meet certain health quality and financial goals.
If they don’t meet those goals, those providers would shoulder more of the cost of treating Medicaid patients. That’s what health policymakers call accountable care, and it’s a model that works well, according to Julia Paradise, an associate director at the Kaiser commission on Medicaid and the Uninsured:
"The more alignment you have among the actors in the health care system I would say the greater the potential at least to produce much more highly coordinated care to point everybody in the same direction with beneficial consequences for patient care and quite possibly savings as well."
Paradise says accountable care programs in other states have shown that it is possible to provide Medicaid patients with high quality health care at a reasonable, predictable cost.
Here in North Carolina, state legislators frequently complain that the cost of paying for Medicaid patients has ballooned in recent years. But that’s largely due to enrollment increases- the fact that more people live in poverty and therefore qualify to be part of the program. Still, many lawmakers like the direction this plan is heading in.
'The quality of these services will impact 1.8 million people in North Carolina and it's very important that the quality of that care stays strong.' - Rep. Nelson Dollar
Republican Representative Nelson Dollar of Cary is one of them. He’s also on the advisory board overseeing the proposal. "As we move toward greater accountability, as we move toward further reform to bend the cost curve, we are very much keeping in mind that the quality of these services will impact 1.8 million people in North Carolina and it’s very important that the quality of that care stays strong, " says Dollar.
The proposal to overhaul the state’s Medicaid plan is likely to go through many changes before state lawmakers approve a final version during their short session in May. But Representative Dollar says he’s optimistic that in the end, both patients and the state will be better served.
