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Managed care companies set sights on N.C. Medicaid market

North Carolina Health News’ Rose Hoban had a great piece out today about the growing interest managed care companies are showing in North Carolina, given the McCrory administration’s hopes of opening up larger pieces of the more than $13 billion program to the private market.

The article highlights an email a Michigan-based company official sent to several Community Care of North Carolina networks asking about future business in the state, even though the legislature hasn’t begun to consider changes to the massive program and several lawmakers have expressed concerns about moving away from CCNC.  CCNC, a non-profit group, currently has a contract with the state to handle majority of the state’s Medicaid patients, and has earned national praise for improving quality of care and cutting costs in large part by connecting patients with primary care physicians who coordinate care.

From the N.C. Health News article:

But that (legislators’ misgivings) hasn’t stopped representatives from managed care companies from reaching out to people within North Carolina in anticipation of change.

In a Sept. 23 email to the head of several of the state’s 14 Community Care Networks, the collaboratives that make up Community Care of North Carolina, Michael Dieterich, a representative from Michigan-based Meridian Health Plan wrote:

“I wanted to reach out to you in order to gain a better understanding of the Community Care of North Carolina (CCNC) relationship that Northwest Community Care Network has in its market.…

“If I were to contract with you, would all of the hospitals, physicians and ancillaries that fall under your umbrella be included in the arrangement or would they need to be negotiated separately? Also, which hospitals, physicians and ancillaries do you represent?”

In his email, Dieterich also mentioned a Medicaid “Request for Proposals,” the process by which government solicits bids for work to be done.

“My first reaction was puzzlement,” said Susan Davis, head of the Community Care Network for Johnston and Wake counties and one of the recipients of the email. As far as I know, there hasn’t been a plan; there’s not an RFP that’s out there.

Hoban’s article also mentions the upcoming departure of Carol Steckel, who had been hired in January to run the state’s Medicaid system but resigned Sept. 24 to take a job with the managed care company WellCareHealth Plans. Hoban described how, on the same day Steckel resigned, Wellcare representatives called up and left voice mails with community health groups connected to CCNC.

From the article:

On the same day, McLean and Davis also received voicemails from a representative of WellCare Health Plans, saying that Medicaid head Carol Steckel suggested he call.

That was also the day Steckel resigned her position as Medicaid head to take a job with WellCare.

When asked about the messages, DHHS spokesman Ricky Diaz wrote in an email that since the governor announced his plan for Medicaid reform, “DHHS has been encouraging dialogue among the health care provider community of how best to meet the governor’s vision of creating a predictable and sustainable Medicaid system that improves care and treats the whole person. While DHHS has not been directing these types of meetings or conversations, it makes sense that it would be happening.”

 

Read the entire article here.

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