Medicaid Reform Work Begins in Earnest

Following three years of discussion, the North Carolina General Assembly took the initial steps this year to begin reforming the Medicaid program. The North Carolina Medical Society has been engaged on this issue since the beginning of the discussion. We continue to advocate for provider-led models of care and are working to make sure doctors and their patients are not negatively affected by reform strategies that have proven bad for patients and ineffective at saving scarce Medicaid resources.

Since the 2015 session of the General Assembly adjourned in September, the NCMS has been meeting with officials from the McCrory administration to focus attention on your key issues in the Medicaid reform debate. Among them, physician leadership, access to the clinical and claims data necessary to organize efficient health care delivery and proper protections for you and your patients as a precaution against inappropriate pressure from corporations or institutions with ulterior motives.

The NCMS supports the Triple Aim, in which payers and providers share simultaneous goals of cost control, population health improvement and patient experience of care improvement (which includes quality).  Within such systems, NCMS supports opportunities for specialty specific alternative payment models, such as prospective bundles. The NCMS is working to identify physician-formulated alternatives that are consistent with these principles. All of these issues will be among our priorities as we make progress toward reform.

The Secretary of the North Carolina Department of Health and Human Services, (DHHS) is required to report to the NC General Assembly on this issue in March 2016. We are working hard in preparation for that deadline. The General Assembly has allowed 18 months after federal approval of North Carolina’s reform plans to select the provider led entities and managed care organizations that will be responsible for the state’s Medicaid beneficiaries, and to begin enrollment. It is impossible to know how long the federal approval process will take, but many observers expect enrollment to begin as early as January 2018.

We want to hear from you about your needs and priorities with respect to Medicaid reform. Please comment on this blog or contact us directly at [email protected] or 800-722-1350.


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