A lot of positive outcomes can occur if North Carolina transforms its proposed Medicaid Reform, Healthy Partnership for North Carolina, into a competitive system where Medicaid beneficiaries are required to have some “skin in the game”. Here’s How:
Competition
Opening doors to competitive contracting amongst three or four managed care organizations (both private and public), known as Comprehensive Care Entities (CCEs). These entities will compete against each other by offering a variety of medical services to eligible Medicaid recipients – yielding lower rates.
These organizations will also be fiscally responsible for any cost overruns and must provide comprehensive care to all Medicaid recipients via risk-stratification. If a patient requires more intensive care, that provider will receive higher reimbursement for service. This incentive prevents cherry-picking, where providers pick out healthier patients to care for.
“Skin in the game”
In old Medicaid, defined benefits for beneficiaries paid for by taxpayers are often unecessarily over-utilized, causing millions of dollars in cost-overruns every year. Money is often spent more wisely, however, when a defined amount is placed in the hands of a patient.
Some states, most notably Florida and Indiana, effectively enforce patient responsibility within their Medicaid reform programs through mandatory copays, work requirements, and personal monthly contributions into a state-funded HSA (Health Savings Accounts).
Positive health outcomes and financial savings have been achieved in both states. And North Carolina possesses the potential to do just the same.
