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CaroMont CEO Shares Perspective on Medicaid Reform and Impact to Local Community

08-10-2015

Source: Orr, Adam (2015, August 9). Is big shift on the way for Medicaid in NC?
The Gaston Gazette. Retrieved from www.gastongazette.com.

The head of CaroMont Health can’t be much clearer about his vision for the future of the state’s Medicaid system.

“We can make some large-scale changes to the system” CaroMont Health CEO Doug Luckett said. “But managed care ain’t it.”

That was Luckett’s message to state lawmakers considering big changes to state’s Medicaid system. Tens of thousands of low-income residents in Gaston and Lincoln counties currently look to the system for their health needs.

Statewide, that number climbs to more than 1.8 million people.

In an effort to trim some of those costs and simplify a complex system, state House and Senate leaders have proposed dueling visions for the future of the state system. The House solution envisions a system similar to the one currently in place. It would put providers, essentially doctors and hospitals, at the center of the process.

But the Senate version would privatize the process in favor of outsidemanaged care organizations. Such a system would outsource the management of the Medicaid program to a private company, which executives like Luckett say would make it harder for doctors and hospitals to treat the state’s poorest patients.

“You’re talking about making it harder for providers to treat their patients, and that makes it harder on the entire system,” Luckett said.

On the front line
Gastonia’s Lori Coates, a registered nurse, has battled pediatric emergencies at times in her career and practically lived inside the operating room at others.

“But what I’m doing right now might be the most rewarding work I’ve ever done,” Coates said.

She’s a community care case manager with Community Health Partners in Gaston County, a nonprofit that serves Medicaid patients in Gaston and Lincoln counties.

It’s one of 14 community networks that make up Community Care of North Carolina. The system manages public Medicaid dollars and doles out payment to coordinate patient care.

It falls to RNs like Coates and other specialists to act as the bridge between primary care providers and particularly difficult patient cases. The idea is to help Medicaid patients, many of whom struggle to understand what can be a complex system, understand how to help themselves.

Sometimes that means in-home visits to help patients understand treatment protocols or simply how to take their medication, Coates said.

“But the idea is to help people before smaller problems become bigger ones,” Coates said. “Sometimes, that’s as easy as picking up the phone and answering their questions, but it’s really patient dependent.”

Predictability
The Senate bill, discussed as part of the state budget battle, would sever ties with Community Care of North Carolina by Dec. 31.

Lawmakers have said they plan to pass a budget by Friday. The goal is to change Medicaid from the current fee-for-service plan — one where doctors and hospitals get paid for each visit and procedure — into a program that would pay a set amount to manage each patient’s care. The payment would go to a group of doctors or an insurance company.

That move could provide lawmakers with more budget predictability in terms of the state’s Medicaid budget. It would also create a seven-member board, called the Department of Medical Benefits, to oversee the program.

That would remove Medicaid from the Department of Health and Human Services and likely shift the management of Medicaid away from local providers and nurse teams like the one to which Coates belongs.

Delays in care for the poor?
Four years ago, Kentucky moved half a million Medicaid patients to three national managed care organizations. That move may have increased delays in getting care, according to a 2012 report by the Urban Institute.

Critics of the proposal, like Luckett, say the current system is designed with patient benefits in mind. He singled out Medicaid’s prenatal care provisions, designed to help low-income mothers and their children get quality medical care early in life, as a measure that heads off problems before they start.

“As for how this will ultimately play out ... I don’t know where the Senate’s head is, and I’m not sure where they’re going with this,” Luckett said.

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