Private HMOs taking over NC Medicaid Program?

It seems far-fetched, but I keep hearing rumors that out-of-state private health insurers are circling the NC Medicaid program, offering the state millions in huge up-front cash payments for the right to take over NC’s Medicaid program. This isn’t new – I wrote nearly three years ago about a private for-profit HMO – Amerigroup – offering to do the same thing. They were rejected back then, but perhaps this company or another one is back for another try.

Given that our fiscal situation, while serious, is less of a problem for the state than last year, I’m not sure how much credence to give this latest talk. Why is this sort of takeover a problem? NC, unlike many other states, resisted the siren song of private HMOs for low-income kids, older adults, and people with disabilities on Medicaid. We built our own nationally-recognized care management program for kids and parents on Medicaid – Community Care of NC. Community Care drastically improves health care by helping doctors deliver the best care possible through techniques like identifying patients who constantly show up in the emergency room for routine care and figuring out solutions to get them back in their family doctor’s office.

Community Care is expanding its proven techniques to older adults and improving care through ideas like medication management. That’s just when someone sits down and takes a look at all the drugs an older adult has been prescribed by multiple doctors to see if there are problem interactions or unnecessary medications being used. Once again, this improves care and has a beneficial effect on costs.

A big part of Community Care is paying doctors fair prices for the care they deliver and helping family doctors with resources (like an extra staff member) to track patients and manage their care. Family doctors and pediatricians all over North Carolina participate in Community Care because: 1. It helps them deliver great care to patients. 2. Doctors help run it. 3. It recognizes the importance of family physicians and pediatricians and their practices all over our state – even in our most rural and non-profit making areas.

Why would a private HMO want to come in to NC? Because they see a great opportunity to make money off of a system that is working for patients. Slash the number of doctors, tamp down reimbursements, and bingo – profits come rolling in and can go to out-of-state stockholders and fat executive salaries. Only one problem. It’s a kick in the eye for the dedicated doctors all over this state who have been seeing Medicaid patients for years, and, more importantly, it’s a sure way to diminish the excellent quality of care NC delivers to kids, moms, older adults, and people with disabilities on Medicaid. Let’s hope the rumors are false.