Category Archives: DHHS Press Release

NC’s DHHS’ Secretary’s Handling of COVID-19: Yay or Nay?

I posted/wrote the below blog in 2017. I re-read my February 10, 2017, blog, which was entitled “NC DHHS’ New Secretary – Yay or Nay?” with the new perspective of COVID-19 being such a hot potato topic and sparking so much controversy. Interestingly, at least to me, I still stand by what I wrote. You have to remember that viruses are not political. Viruses spread despite your bank account, age, or location. Sure, variables matter. For example, I am statistically safer from COVID because I live on a small, horse farm in North Carolina rather than an apartment in Manhattan.

The facts are the facts. Viruses and facts are not political.

I was surprised that more people did not react to my February 10, 2017, blog, which is re-posted below – exactly as it was first posted. For some reason (COVID-19), people are re-reading it.

___________________________________

Our newly appointed DHHS Secretary comes with a fancy and distinguished curriculum vitae. Dr. Mandy Cohen, DHHS’ newly appointed Secretary by Gov. Roy Cooper, is trained as an internal medicine physician. She is 38 (younger than I am) and has no known ties to North Carolina. She grew up in New York; her mother was a nurse practitioner. She is also a sharp contrast from our former, appointed, DHHS Secretary Aldona Wos. See blog.

cohen

Prior to the appointment as our DHHS Secretary, Dr. Cohen was the Chief Operating Officer (COO) and Chief of Staff at the Centers for Medicare and Medicaid Services (CMS). Prior to acting as the COO of CMS, she was Principal Deputy Director of the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS where she oversaw the Health Insurance Marketplace and private insurance market regulation. Prior to her work at CCIIO, she served as a Senior Advisor to the Administrator coordinating Affordable Care Act implementation activities.

Did she ever practice medicine?

Prior to acting as Senior Advisor to the Administrator, Dr. Cohen was the Director of Stakeholder Engagement for the CMS Innovation Center, where she investigated new payment and care delivery models.

Dr. Cohen received her Bachelor’s degree in policy analysis and management from Cornell University, 2000. She obtained her Master’s degree in health administration from Harvard University School of Public Health, 2004, and her Medical degree from Yale University School of Medicine, 2005.

She started as a resident physician at Massachusetts General Hospital from 2005 through 2008, then was deputy director for comprehensive women’s health services at the Department of Veterans Affairs from July 2008 through July 2009. From 2009 through 2011, she was executive director of the Doctors for America, a group that promoted the idea that any federal health reform proposal ought to include a government-run “public option” health insurance program for the uninsured.

Again, I was perplexed. Did she ever practice medicine? Does she even have a current medical license?

This is what I found:

physicianprofile

It appears that Dr. Cohen was issued a medical license in 2007, but allowed it to expire in 2012 – most likely, because she was no longer providing medical services and was climbing the regulatory and political ladder.

From what I could find, Dr. Cohen practiced medicine (with a fully-certified license) from June 20, 2007, through July 2009 (assuming that she practiced medicine while acting as the deputy director for comprehensive women’s health services at the Department of Veterans Affairs).

Let me be crystal clear: It is not my contention that Dr. Cohen is not qualified to act as our Secretary to DHHS because she seemingly only practiced medicine (fully-licensed) for two years. Her political and policy experience is impressive. I am only saying that, to the extent that Dr. Cohen is being touted as a perfect fit for our new Secretary because of her medical experience, let’s not make much ado of her practicing medicine for two years.

That said, regardless Dr. Cohen’s practical medical experience, anyone who has been the COO of CMS must have intricate knowledge of Medicare and Medicaid and the essential understanding of the relationship between NC DHHS and the federal government. In this regard, Cooper hit a homerun with this appointment.

Herein lies the conundrum with Dr. Cohen’s appointment as DHHS Secretary:

Is there a conflict of interest?

During Cooper’s first week in office, our new Governor sought permission, unilaterally, from the federal government to expand Medicaid as outlined in the Affordable Care Act. This was on January 6, 2017.

To which agency does Gov. Cooper’s request to expand Medicaid go? Answer: CMS. Who was the COO of CMS on January 6, 2017? Answer: Cohen. When did Cohen resign from CMS? January 12, 2017.

On January 14, 2017, a federal judge stayed any action to expand Medicaid pending a determination of Cooper’s legal authority to do so. But Gov. Cooper had already announced his appointment of Dr. Cohen as Secretary of DHHS, who is and has been a strong proponent of the ACA. You can read one of Dr. Cohen’s statements on the ACA here.

In fact, regardless your political stance on Medicaid expansion, Gov. Cooper’s unilateral request to expand Medicaid without the General Assembly is a violation of NC S.L. 2013-5, which states:

SECTION 3. The State will not expand the State’s Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, P.L. 111-148, as amended, for which the enforcement was ruled unconstitutional by the U.S. Supreme Court in National Federation of Independent Business, et al. v. Sebelius, Secretary of Health and Human Services, et al., 132 S. Ct. 2566 (2012). No department, agency, or institution of this State shall attempt to expand the Medicaid eligibility standards provided in S.L. 2011-145, as amended, or elsewhere in State law, unless directed to do so by the General Assembly.

Obviously, if Gov. Cooper’s tactic were to somehow circumvent S.L. 2013-5 and reach CMS before January 20, 2017, when the Trump administration took over, the federal judge blockaded that from happening with its stay on  January 14, 2017.

But is it a bit sticky that Gov. Cooper appointed the COO of CMS, while she was still COO of CMS, to act as our Secretary of DHHS, and requested CMS for Medicaid expansion (in violation of NC law) while Cohen was acting COO?

You tell me.

I did find an uplifting quotation from Dr. Cohen from a 2009 interview with a National Journal reporter:

“There’s a lot of uncompensated work going on, so there has to be a component that goes beyond just fee-for service… But you don’t want a situation where doctors have to be the one to take on all the risk of taking care of a patient. Asking someone to take on financial risk in a small practice is very concerning.” -Dr. Mandy Cohen

Passing the Torch: Wos Resigns!! Brajer Appointed!

Aldona Wos resigned today after two years and seven months as Secretary of NC DHHS.  Wos’ last day will be Aug. 14.

McCrory named Rick Brajer, a former medical technology executive, as the new Secretary of DHHS.

Soon-to-be Sec. Brajer, 54, was the chief executive of ProNerve and LipoScience.  LipoScience was sold to LabCorp in 2014, and ProNerve was sold to Specialty Care in April.

Brajer is not a doctor, as Wos was.  Instead, Brajer touts an MBA from Stanford.

I do not have any information as to why Wos resigned now, especially in light of the recent resignation of the Secretary of Transportation, but will keep you apprised.

More to come….

NCTracks’ One-Year Anniversary Is Celebrated with a Newly-Released, NCTracks, Congratulatory, SUCCESS Video! You agree?

Happy Anniversary, NCTracks!!!!  Tomorrow is the one-year anniversary of NCTracks going live.

DHHS TV released a video touting the wonderful success of NCTracks, despite its, admittedly, rocky start (The video admits a rocky start).  In the video, health care providers gush over how wonderful NCTracks is and its success.  I have no comment due to the current pending litigation. Therefore, I am merely reporting the release of the video and asking whether you agree.

See the DHHS TV video here: .

Sebelius Out, Burwell In: A New Secretary to Lead the Department of Health and Human Services (Federal)

The following article is breaking news on the Health Care Policy Report:

The Senate June 5 voted 78-17 to confirm Sylvia Mathews Burwell as secretary of the Department of Health and Human Services.

Republicans who voted against the nomination included Senate Minority Leader Mitch McConnell (R-Ky.), who in an earlier floor statement compared voting for the nomination to appointing a “new captain for the Titanic.” Other Republicans who voted against the nomination included Roy Blunt (Mo.), Ted Cruz (Texas), John Cornyn (Texas), Pat Roberts (Kan.) and John Thune (S.D.).

In urging his colleagues to vote in favor of the nomination, Finance Committee Chairman Ron Wyden (D-Ore.) said that Burwell enjoys bipartisan support and that Republicans and Democrats will need to work together to ensure the future of Medicare.

Burwell, director of the Office of Management and Budget, will replace Kathleen Sebelius, who announced her resignation in April but agreed to stay on until a successor is confirmed.
Burwell has sailed through Senate committee hearings and a committee vote, and easily passed a procedural vote June 4 when 14 Republicans voted with Democrats, 67-28, to end debate on the nomination.

DHHS Presents Medicaid Reform Plan to the General Assembly

Press Release

DHHS Presents Medicaid Reform Plan to the General Assembly

 

FOR IMMEDIATE RELEASE
Monday, March 17, 2014

Contact: news@dhhs.nc.gov
919-855-4840

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

 

NC Medicaid: With Diaz Gone, Who Will Provide the Cheery Soundbites About NC DHHS?

You know you know someone like this! No matter how horrible the circumstance, they just say positive things.  You know, like a Disney character…oblvious to reality. Think about Snow White…her step-mother wants to kill her, she is run into the deep forest by a huntsman who was supposed to kill her, she is told to NEVER return home, she finds 7, extremely, short men with whom she has to live (smelly) and become their maid (dirty), yet she whistles while she works!

So to was Ricky Diaz, the communications director for the North Carolina Department of Health and Human Services (DHHS).  In the face of NCTracks’ catastrophic roll out, Diaz says, “While we’re pleased with the success of the new system…”

And

“Although NC Tracks has processed more claims than it has denied…”

And

NC Tracks has now processed more than 15 million claims that paid health care providers more than $1.1 billion, according to Diaz.

And

Diaz said he does not feel as though the state rushed into this transition. “We processed more than 15 million claims and paid health care providers more than $750 million during July,” he emphasized.

And (my personal favorite, in a DHHS News Release after the go-live date)

“NCTracks is on track.”

“Whistle while you work…”  Well this cheery, optimistic communications director resigned.  His resignation came on the heels of providing reporters false information about the Medicaid debacle.  See my blog: “DHHS Blunder Could Cost Millions! “Oops I Did It Again.””

Ricky Diaz announced his resignation today (Wednesday, January 8, 2014) on Twitter, saying he is proud to be joining a small public affairs and media relations firm in Washington, D.C.

“Proud to be joining…” That’s our Ricky…upbeat and positive…”Whistle while you work…”

Happy Ricky

But now who will provide us with the positive soundbites for the media?

Is Sec. Aldona Wos Challenging the Goliath-Like MCOs? Will She Win?

I attended a Women in Leadership conference the other day. The keynote speaker asked for us to come up with a one sentence mantra or mission statement that we would use to describe our purpose in life.  I had never thought about what my life purpose is…my career?..being a mom?….being a wife?

As a woman, I was torn.  Was I a bad mom if I thought my “purpose of being” was my career?  Do all women feel this? Was I a bad wife if I thought my “purpose of being” was my career?  Does my career define me?  I decided that what defines me are the indirect consequences of my career? (i.e., those who benefit from my advocacy, but could never hire me).

So my mission statement came out on paper as: I am here in order to advocate for the voiceless.

I have a rare opportunity with my career choice to indirectly help Medicaid recipients (the voiceless) by serving the providers who serve recipients.  Obviously, Medicaid recipients cannot afford me or any other attorney.  But, by serving those that serve recipients, indirectly I am serving recipients.  For a more detailed explanation why I love my job, see my blog on Why I Have the Most Rewarding Career.

Sometimes, however, my job feels like I am David fighting Goliath.  No…the flea on David’s shoe while he is fighting Goliath.

In my own head, I have always felt that changing government policy (fighting DHHS) is a true David and Goliath story.

Which, finally, brings me to my point.  For those of you who have been reading my blogs, how many times have I blogged about MCOs not providing medically necessary mental heath care services??? Or Medicaid recipients being incarcerated or hospitalized because the MCOs were denying mental heath care services?  But never have I written that DHHS is not providing the medically necessary mental heath care services, quite frankly, because DHHS has stood back and allowed the MCOs to run rampant.

Since the inception of the MCOs statewide, in my opinion and from what I see every day, the MCOs have increasingly taken more and more steps to deny more services, terminate more provider contracts, and recoup more money from providers.  And DHHS has taken less and less steps to supervise, oversee or manage the MCOs.  By the MCOs increasingly having a “I can do what I want attitude,” and DHHS increasingly having a “I can’t tell an MCO what to do” attitude, when it comes to the MCOs, the MCOs’ power has grown while DHHS’ ability to manage the MCOs has shrunk.  Thus, in the behavioral health care world, the MCOs have morphed into the Goliaths.  DHHS is an onlooker, and I am still the flea on David’s shoe.

Thereby creating a counterintuitive situation in which Sec. Wos is David and the MCOs are the Goliath. (Normally DHHS would be Goliath).

I have written approximately 230 blogs. (really???).  I would wager a guess that over half of my blog topics have been MCOs denying medically necessary mental health services or MCOs reaping monetary rewards for terminating provider Medicaid contracts or denying services to Medicaid recipients.

The flea on the shoe of David fighting Goliath.

But….perhaps….last week….the flea was noticed.

Last week the Department of Health and Human Services (DHHS) (actually, Secretary Aldona Wos) announced a new mental health, substance abuse effort.

What is that new effort?

Sec. Wos announced, what she called the “Crisis Solutions Initiative.”  “DHHS estimated that there were 150,000 visits to emergency rooms in the state last year for addition-related issues or psychiatric conditions.”  See The Progressive Pulse blog.  Remember my blog, “Prisons and Emergency Rooms: Our New Mental Health Care Providers?”

Sec. Wos, in a written statement, states “With today’s announcement, we begin a focused, long-term effort to ensure that individuals and families who are experiencing a mental health or substance abuse crisis know where to turn for the help they need.  In turn, we can begin to reduce the tremendous burden that these issues place on hospital emergency departments and law enforcement.”

OMG…did she read my blog???? (And even more crazy….and agree???????)

Whether it was my blog, true statistics brought to her attention, or an epiphany, it does not matter.  Bravo, Sec. Wos, but, please follow through.

The fact of the matter is if Sec. Wos wants to “reduce the burden on hospital ERs and law enforcement” AND truly provide Medicaid recipients with mental health/substance abuse issues, Sec. Wos will have to take on the MCOs head-on.  Grab the bull by the horns.  Pony-up.  Put your big, boy pants on.  Just do it! (Nike). Buck up…against the MCOs. The Goliaths will have to be defeated.

Why?

Here a  little secret:  The MCOs have monetary incentive to deny medically necessary mental health services….WHAT???? Shut the front door!!!

Let me explain:

The managed care organizations (MCOs) in NC are managing behavioral health care services for Medicaid recipients.  However, the MCOs are pre-paid.  What does that matter?  It’s all about the money.

For example, a Medicaid recipient suffers schizophrenia with auditory and visual hallucinations.  (We will call him Bill).  Bill’s psychiatrist, after an assessment, requests assertive community treatment team services (ACTT), which is an extremely high-level mental health service (and very expensive).  The MCO denies ACTT services based on “failing to exhaust lesser intensive services” (which is NOT a criterion for entrance criteria, but DHHS is not supervising or managing the MCOs, so who cares whether the MCOs follow DHHS policy).  Bill becomes incarcerated.  Yes, it is more expensive for tax payers to pay for Bill’s incarceration versus the community based services requested, but it is cheaper for the MCO.  The MCO does not pay the prison for Bill’s room and food; tax payers do.  The MCO is successful in keeping its money.  Similarly, Bill becomes hospitalized.  The hospital admits Bill into Butner or Holly Hill.  Sure it is more expensive for tax payers to pay for Bill’s stay at Butner or Holly Hill, but it is cheaper for the MCO.  The MCO does not pay Butner or Holly Hill; the tax payers do.  The MCO is successful in keeping its money.

But, according to the Press Release from DHHS, Sec. Wos wants to stop the MCOs from pushing the mentally ill to prisons and emergency rooms.  But in order to stop the MCOs, she will have to stop the Goliaths (MCOs).

Interestingly, everyone always thinks of David as the underdog to Goliath and, therefore, is surprised/excited when David beats Goliath.  In reality, according to “David and Goliath: Underdogs, Misfits, and the Art of Battling Giants,” a book by Malcolm Gladwell, David was not the underdog.  According to Gladwell, Goliath suffered from acromegaly or, more commonly known as, gigantism, which can cause people to grow to abnormal heights. People who suffer from acromegaly, usually, also suffer other symptoms, such as poor eyesight and mobility.  Yes, Goliath looked scary and big, but, in reality, he may have been slow and somewhat blind.  Remember his words to David?  “Come to me so that I may feed your body to the birds of the air…”  “Come to me.”  As in, I cannot see you yet.  Come closer.

Furthermore, David was a trained “slinger.”  As in, the person in battle back then who did not wear armor and who became skilled at slinging rocks at high speeds to kill opponents.  Imagine a major league baseball player with a fast ball of 100mph throwing the ball directly at your head.  David was a shepherd, and he became a master with the sling to kill the wild life attacking his sheep.  Back in biblical times, being large, massive and heavily armored against a master slinger would be like bringing a butter knife to a gun fight.  Goliath had no chance.  David was smart.  Sec. Wos will need to be smart too, maybe even a master slinger.

A portion of the DHHS press release reads, “As a part of this initiative, a Crisis Solutions Coalition will be created to address the inefficiencies that currently exist surrounding crisis services in the state. Secretary Wos has charged Dave Richard, director of the DHHS Division of Mental Health, Developmental Disability and Substance Abuse Services, with leading this coalition. Patient advocates, along with leaders from healthcare, government, and law enforcement communities will be invited to join the coalition to help:

  • Recommend and establish community partnerships to strengthen the continuum of care for mental health and substance abuse services.
  • Promote education and awareness of alternative community resources to the use of emergency departments.
  • Make recommendations related to data sharing to help identify who, when and where people in crisis are served, and what the results of those services are.
  • Create a repository of evidence-based practices and provide technical assistance to Local Management Entities/Managed Care Organizations (LME/MCOs), law enforcement and providers on how to respond to crisis scenarios.
  • Recommend legislative, policy and funding changes to help break down barriers associated with accessing care.
  • Assist with the creation of LME-MCO Local Business Plans to provide a road map for mental health investments in the community.”

Hospitals are ecstatic and they should be!  “I want to thank Governor McCrory, Secretary Wos and the Department of Health and Human Services for their commitment to this issue,” said Dr. Bill Roper, CEO of UNC Health Care. “We look forward to partnering with you and the community to solve the mental health problems facing our state.”

The prisons should be ecstatic too.

Herein lies the problem…the MCOs are, most likely, NOT ecstatic.  Sec. Wos, by announcing this crisis solution, has placed her hand in the MCOs’ cookie jars.

Goliath will challenge David. “Come to me.”

Can you imagine the backlash by the MCOs if Sec. Wos actually followed through with this crisis solutions? In order to follow through with the crisis solutions, Sec. Wos will have to force the MCOs to authorize medically necessary mental health care services.  With more services authorized, there will be a greater need for providers who accept Medicaid; thus reducing the number of terminations of provider’s Medicaid contracts.

Because if Sec. Wos wants, as she stated in the Press Release, to stop the revolving doors at the hospitals for the mentally ill, Sec. Wos has to take on the MCOs.  DHHS will have to do its job and supervise/manage the MCOs.

But can David be smart enough? Or will the Goliaths prevail?

“Come to me.”