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Veteran physician: Improve public Medicaid system; don’t sell it to private HMO’s

MedicaidAs Governor McCrory and his HHS Secretary Aldona Wos convene a rather strange closed door “listening  session” on Medicaid in Greensboro today (it’s scheduled to last all of 45 minutes), let’s hope they both took the time over the weekend to read an excellent, “from-the-trenches” essay by Goldsboro physician Dr. David Tayloe in Raleigh’s News & ObserverIn it, Tayloe explains the importance of preserving and improving North Carolina’s homegrown “medical home” model for delivering Medicaid services (Community Care of North Carolina) rather than falling for the false promises of out-of-state HMO companies that have been trying to muscle their way into the state.

CCNC is rooted in care coordinated by providers, not insurance corporations. By keeping care decisions in the hands of those most qualified to make them, medical home models improve health outcomes for North Carolina’s Medicaid population. Doctors, care managers and pharmacists across provider-led networks share data and best practices to provide efficient and high-quality care to patients, decreasing emergency room visits and reducing wasteful spending.

The CCNC model is the result of decades of work that has consistently generated positive results in North Carolina. An HMO takeover of this system would mean higher administrative costs to the state and billions of taxpayer dollars leaving the state to pay corporate shareholders. Under federal Medicaid rules, the additional money required to pay HMOs can come from only one place – sharp cuts to provider payments. When physicians choose not to participate in Medicaid, patients neglect preventive care and head to the emergency room in crisis, raising state costs while producing less positive health outcomes.

As president of the American Academy of Pediatrics (2008-2009), I had the opportunity to discuss Medicaid with pediatricians all over the country. It became obvious that CCNC is the best model available for taking good care of Medicaid patients. It concerns me that our state would scuttle a proven care model in return for a for-profit system that primarily benefits special interests outside the state.

I would hope that our leaders would go forward with cost-saving initiatives that assure CCNC will continue to provide cost-effective, high-quality care for patients who rely on Medicaid in our state. If North Carolina moves to an HMO model, doctors will leave the program, patients will have less access to care and a primary care infrastructure that is the envy of other states will be lost.

Read Dr. Tayloe’s entire op-ed by clicking here.

2 Comments

  1. GirlfriendMD

    July 21, 2014 at 12:43 pm

    Amen and I agree. I went to a pediatrics conference at Harvard in 2009, and when I asked a question at one of the presentations about chronic disease management in children, the speaker asked where I was from. When I told him North Carolina, he excitedly said, “You have the BEST system in the US for your medicaid patients for chronic disease management. You guys are the model!!!”
    I have worked in a “managed care” style Medicaid system in Tennessee, and while that state had insurance coverage for everyone who needed it (a major bragging point), many patients actually had to leave the state for specialty care. For example, for TennCare patients, there was not a single neurologist in the state of TN who would accept their coverage, because payment was abysmally low. Some specialties lost money seeing Medicaid patients, so would just drop them completely.
    Managed care style Medicaid systems have failed in multiple states to provide better outcomes or to save money. The only people who consider it successful are the MCOs that are actually profiting on the backs of the taxpayers and the most medically vulnerable populations in those states.
    I pray and pray that McCrory is wise enough to view the other state experiments that have been done in this area and see them for the money grabbing failure that they are.

  2. Gene Hoglan

    July 21, 2014 at 2:05 pm

    But how are the Job Creators™ supposed to create all those jobs unless they rob the state treasury?