Category Archives: Medicaid Reform Advisory Group
DHHS Presents Medicaid Reform Plan to the General Assembly
Raleigh, N.C. – The North Carolina Department of Health and Human Services (DHHS) today presented its Medicaid reform plan to the General Assembly. This realistic and achievable plan puts patients first, improves whole person care, ensures a more predictable Medicaid budget, and builds on what already works for North Carolina.
“We have an obligation – an obligation we have willingly accepted as a state – to help those in need. And we must, at the same time, be good stewards of taxpayer resources,” said DHHS Secretary Aldona Z. Wos, M.D. “We believe this Medicaid reform plan is responsive to both those obligations.”
The plan proposes that providers collaborate through accountable care organizations (ACOs), a model that allows physicians and other providers who care for patients to take control of improving quality and healthy outcomes.
“When ACOs share in the savings or losses based on quality measures, everyone has a vested interest in making Medicaid a success,” said Secretary Wos. “We expect the ACO model to bend the cost curve by approximately 2-3 percent, which would mean hundreds of millions of dollars in savings for the state.”
The reform plan is based on input received during nearly 15 months of discussions with stakeholders throughout the state, including beneficiaries, caregivers, providers, health care organizations and the work of the Medicaid Reform Advisory Group.
“The reform proposal being submitted today to the General Assembly is a good and thoughtful plan,” said Dennis Barry, advisory group chair and CEO emeritus of Cone Health. “Importantly, it builds on the existing strengths of the current care systems operating in North Carolina.”
DHHS is taking a dual approach to Medicaid reform as efforts also are under way to improve the Division of Medical Assistance (DMA) operations to support Medicaid reform.
Secretary Wos recently named Deputy Secretary of Health Services and Acting State Health Director Robin Gary Cummings, M.D., to lead the DMA transformation. He is overseeing efforts to improve existing operating processes to increase forecasting accuracy and deliver Medicaid services more efficiently and effectively.
Since its inception in 1970, the N.C. Medicaid program has evolved into an essential component of the state’s health care system. It currently serves about 1.8 million low-income parents, children, seniors and people with disabilities and requires $13.5 billion a year to operate.
Medicaid Advisory Group members include Dennis Barry of Greensboro, chair, CEO emeritus of Cone Health; Peggy Terhune, Ph.D., of Randolph County, executive director and CEO of Monarch; Richard Gilbert, M.D., of Mecklenburg County, former chief of staff for Carolinas Medical Center; state Rep. Nelson Dollar of Wake County and state Sen. Louis Pate, who represents Lenoir, Pitt and Wayne counties.
For a copy of the Medicaid reform plan, click here.
By EMERY P. DALESIO, Associated Press
RALEIGH, N.C. (AP) — Gov. Pat McCrory’s health agency on Wednesday planned to unveil its latest version of ideas on how to change North Carolina’s $13 billion Medicaid health care system for about 1.7 million poor and disabled people.
The state Department of Health and Human Services was scheduled to present its framework for revamping Medicaid to an advisory group set up by McCrory. The plan could get some touch-ups before it’s presented to state lawmakers next month. The Legislature is expected to take up the proposed changes beginning in May.
It’s been almost a year since McCrory and state health Secretary Aldona Wos proposed largely privatizing management of Medicaid while keeping ultimate responsibility in state hands. About $3.5 billion of the shared state and federal program’s cost is paid by state taxpayers.
McCrory and Republican legislative leaders have blamed spiraling Medicaid costs left by preceding Democratic administrations for not providing teachers and state workers with raises last year. But Medicaid has also proved tough to manage under the GOP’s watch.
McCrory has said overhauling Medicaid is at the top of his legislative agenda and “may be the toughest battle” with lawmakers cool to earlier ideas to pay managed-care organizations a set fee and force them to work out how to deliver care within that budget.
The North Carolina Medical Society — which represents about 12,500 physicians and physician assistants in the state — the North Carolina Hospital Association, and other advocates for medical professionals and consumers have proposed a more conservative shifting of the risk for cost overruns.
The groups proposed expanding the more than 20 accountable care organizations already operating across North Carolina. The small networks of physicians or hospitals are paid by Medicaid for each procedure they perform. Organizations that meet savings and treatment goals get to keep a portion of the savings generated. If patient costs exceed standards, it must share losses with the state.
Problems in North Carolina’s Medicaid program have persisted for years and haven’t quit since McCrory took office last year and installed Wos as DHHS secretary.
A decision by the agency to delay recalculating Medicaid patient eligibility for three months could cost the state up to $2.8 million. Lawmakers have criticized the agency for not reporting those costs while they were developing the state budget last summer.
A group of North Carolina doctors filed a class-action lawsuit last month after flawed computer programs severely delayed payments they were due for treating Medicaid patients. The lawsuit alleges that managers at DHHS and its contractors were negligent in launching NCTracks, a nearly $500 million computer system intended to streamline the process of filing Medicaid claims and issuing payments.
The lawsuit alleged NCTracks’s software was riddled with thousands of errors that led to delays of weeks and sometimes months before doctors and hospitals received payment. That forced some medical practices to borrow money to meet payroll and others to stop treating Medicaid patients, the lawsuit said.
Earlier this month, DHHS announced it would spend up to $3.7 million on no-bid, personal service contracts with two firms that would advise the agency on running the Medicaid program. Internal McCrory administration memos released to The News & Observer of Raleigh describe understaffed and underskilled workers in the Medicaid division needing emergency help.
FOR IMMEDIATE RELEASE
Monday, December 2, 2013 Contact: firstname.lastname@example.org
Raleigh, N.C. – The public is invited to the Medicaid Reform Advisory Group’s first meeting Dec. 5, 2013. The advisory group will collaborate with the Department of Health and Human Services in its development of a detailed plan to reform North Carolina’s Medicaid system. The public is encouraged to attend the meeting and become involved in improving health care in North Carolina while controlling escalating Medicaid costs.
The meeting will be held from 10 a.m. to 1 p.m., Dec. 5, 2013, at:
The Grill on the Hill
DHHS/Dorothea Dix Campus, behind the McBryde Building
Parking is available off of Whiteside Drive. A map of the DHHS/Dorothea Dix campus is available at http://www.ncdhhs.gov/dsohf/services/dix_map.pdf <http://ncdhhs.us4.list-manage.com/track/click?u=58ec19aaea4630b1baad0e5e4&id=034d4a8058&e=678f6cc5b6> .
The first meeting will help:
- Educate members on reform models in other states
- Build consensus on principles of reform
- Outline options for reform
The Medicaid Reform Advisory Group, as instructed by the General Assembly, will obtain broad stakeholder input in a public forum and ensure transparency in the proposal development process. The advisory group will work with DHHS as it explores all options to come up with the best plan for North Carolina, and has three citizens appointed by Governor McCrory, a state representative and senator:
- Dennis Barry (Guilford County), advisory group chair – Barry is CEO emeritus of Cone Health, a multihospital system serving the Piedmont region of North Carolina.
- Peggy Terhune (Randolph County) – Terhune is the executive director/CEO of Monarch since 1995. She has worked with people with disabilities for more than 35 years.
- Richard Gilbert, M.D., M.B.A. (Mecklenburg County) – Dr. Gilbert has served as the chief of staff for Carolinas Medical Center and was the chief of the Department of Anesthesiology for Carolina’s Medical Center for 20 years.
- Representative Nelson Dollar (Wake) – Appointed by House of Representatives Speaker Thom Tillis.
- Senator Louis Pate (Lenoir, Pitt, Wayne) – Appointed by Senate President Pro-Tempore Phil Berger.
More information on the governor’s appointees can be found at governor.nc.gov/newsroom/press-releases <http://ncdhhs.us4.list-manage.com/track/click?u=58ec19aaea4630b1baad0e5e4&id=d02b8f54b1&e=678f6cc5b6> .
Since its inception in 1970, the N.C. Medicaid program has evolved into an essential component of the state’s health care system. It currently serves approximately 1.7 million low-income parents, children, seniors and people with disabilities.
The Medicaid Reform Advisory Group will hold additional meetings during which stakeholders will have the opportunity to publicly comment on the reform process. Public notices will be issued with the dates, times and locations.
DHHS will present a reform proposal to the General Assembly no later than March 17, 2014.