This past Wednesday evening, Medicaid Director Carol Steckel and HHS Secretary Aldona Wos hosted a meeting discussing Governor Pat McCrory’s release of North Carolina’s Medicaid reform, also known as Partnership for a Healthy North Carolina.
The meeting focused on the concept of “one”. The Partnership for a Healthy North Carolina will operate under one financial system for provider reimbursement as well as one IT system for eligibility determination. Services must be provided seamlessly by both physical and mental medical providers per one patient.
Steckel remarked on the holistic framework of the reform:
Providing quality care around one person is a dream come true
There will be one and only one entry point for eligible Medicaid enrollees into three or four Comprehensive Care Entities (CCEs), or competing managed care networks of insurers and providers. If patients enter any type of medical facility and qualify to receive Medicaid benefits, they will be entered into the IT system and undergo a medical needs assessment via a CCE provider.
The CCEs will be responsible for comprehensive care for ALL Medicaid enrollees through“risk-stratification”. If a patient requires intensive medical needs, medical providers will be reimbursed at higher rates. This incentive will prevent cherry-picking, in which providers choose to care for less costly, healthier patients. Providers will also be reimbursed on a PMPM (per member per month) payment model.
While providers must cooperate as a team and follow each patient’s needs, it is of utmost importance for Medicaid enrollees to follow through with providers’ prescriptions to fully achieve better health outcomes. Personal responsibility must be demonstrated.
Steckel noted that the current Medicaid program has a projected shortfall between $70-$132 million this fiscal year. Much of this shortfall can be attributed to duplicative services and high administrative costs.
For more information on the framework of Partnership for a Healthy North Carolina, click here.
