- The Progressive Pulse - http://pulse.ncpolicywatch.org -

Lawmakers want changes from Community Care health care system

A bill filed yesterday at the state legislature to make the prices hospitals charge for procedures more easily accessible to patients demands significant change to the leadership of Community Care of North Carolina [1], a health care management system run by providers.

Hospitals would have to be more upfront about what they charge for common procedures, according to an article [2] in today’s Charlotte Observer. The Charlotte Observer, along with the News & Observer, published an investigation “Prognosis: Profits [3]” that found many public hospitals in the state had soaring profits while patients paid exorbitant prices for procedures and required charity care was offered at minimal levels.

But the bill would also change the structure of Community Care of North Carolina, a health care system that works with the state to manage care  on the community level for Medicaid patients.

Community Care has received national praise for its model of care, which sought to reign in Medicaid spending by creating a doctor-run system to match primary-care providers with patients to avoid costly emergency room visits. Senate Bill 473, the “HealthCare Cost Reduction and Transparency Act [4]”  introduced Thursday by Sens. Bob Rucho and Harry Brown, would shift the leadership team of Community Care away from providers and demand that the organization change its board of directors in order to do business with the state.

The bill proposes that the state cap its board at 13 members, with one-quarter or less of its members being providers like doctors, and creating slots for four appointment from the legislature, two from the governor, the head of the state’s Medicaid office, a health actuary, a business owner, a health insurance industry representative and health IT expert.

The board’s current makeup consists largely of doctors and health care directors. The bill would also prevent any providers that are recipients of Community Care work from serving on the board that sets the reimbursement prices for procedures.