On May 1, Triad HealthCare Network (THN) in Greensboro hosted the North Carolina Accountable Care Organization (NCACO) Collaborative, including over 30 doctors, administrators and others involved with or interested in learning more about ACOs in North Carolina. Included in the group were representatives from the State Employee Health Plan, who came to learn how they could partner with the ACO community to better serve their enrollees.
Steve Neorr, vice president and executive director of THN, described his organization’s successes and challenges. THN is comprised of 850 physicians of whom about 360 are employed through the Cone Health System. This includes 277 primary care providers across four counties around Greensboro and affiliations with six hospitals — all part of Cone. Neorr added that within their network there are 30 different EHR systems to integrate — no small IT challenge.
Neorr acknowledged the crucial role that Cone Health has played in their success thus far and Cone’s willingness to “let physicians drive the change.” He also noted that the non-medical drivers of cost have had a huge impact.
“Our community care management, home assessments and interventions have been most effective,” he said. “We have come to a better understanding of the resources in our community — not just the doctors and patients. We’ve involved the whole community.”
Some of the most frustrating issues involve the lack of ability to influence beneficiary behavior through benefit design or other incentives, Neorr said. With discussion revolving around moving to full risk contracts, the group seemed to agree that in order for an ACO to assume full risk, the organization would need full control over the network, payments, incentives and benefit design. Other key questions would include how to define risk and how many people would an ACO need to cover to reduce their actuarial risk?
By discussing these important questions and sharing experiences, the collaborative aims to work through some of these unresolved issues with ACOs. The NC State Health Plan representatives at the meeting expressed their willingness to partner with ACOs across the state to best serve their 670,000 enrollees.
Other items on the agenda included a report from Stephen Nuckolls, CEO of Coastal Carolina Health Care in New Bern on the National Association of ACOS (NAACOS) meeting in Baltimore at the end of April. This national organization includes about 100 ACOs from across the country that come together to learn from each other and advocate for the model. Nuckolls reported that representatives from the Centers for Medicare and Medicaid Services attended the conference and listened to the ACOs critique of the Medicare Shared Savings Program (MSSP) and the changes necessary.
The North Carolina Medical Society’s (NCMS) General Counsel and Deputy Executive Vice President for Government Affairs & Health Policy Steve Keene updated the group on the state’s latest proposal to reform Medicaid.
Every year since 1997 the NCMS fights a rate cut for Medicaid providers in the General Assembly, Keene said. Over the last year, the Department of Health and Human Services has been looking at alternatives to the status quo and have realized there are three options — a rate cut to physicians, bringing in managed care organizations, both of which the NCMS adamantly opposes, or moving toward an ACO model, which the NCMS has endorsed throughout the process.
Currently, it seems the legislature is not prepared to completely overhaul the system, but Keene said they are likely “to take a few affirmative steps toward having a value-based system in the future.”
