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MedicaidThe following essay comes from Dr. William Dennis, President of the North Carolina Academy of Family Physicians:

Senate spending plan: The wrong treatment plan for an incorrect diagnosis

As a family physician, I am trained to process and understand the symptoms my patients present for the sole purpose of making a correct diagnosis. Once the correct diagnosis is made, it becomes my imperative to develop a treatment plan that addresses the underlying health concerns, not just remedy a patient’s symptoms. Only then can I deploy the necessary healthcare resources to ensure the best possible outcomes for my patients. Successful Medicaid reform is no different.

Over the past 16 months the state’s healthcare community, working closely with the General Assembly, the Governor, the Medicaid Reform Advisory Group and representative patient advocates, have made tremendous progress in diagnosing the ills of our Medicaid system and proposing priorities for reform and continued investment.

Some of these include:

• Improved Budget Forecasting – The actual spending per Medicaid recipient has been decreasing, with overall claims spending growing at a rate lower than the growth in the number of Medicaid recipients. The most significant cause for continued cost overruns is linked to budgeting inaccuracies, not care delivery.

• Continued Investment in “Medical Homes” – Community Care of North Carolina’s (CCNC) nationally recognized platform of “medical homes” provides services and care that is better coordinated to meet the needs of each patient. They leverage technology and care management to prevent chronic disease where possible, and maintain patient course of treatment where necessary, all of which reduces costly occurrences of hospital re-admissions and unnecessary emergency room visits.

• Adoption of New Payment Mechanisms – Movement away from the current fee-for-service model that ties compensation to volume of patients seen, towards physician-led accountable care organizations that reward improved health outcomes by focusing on prevention and chronic disease management.

But last week’s Senate Spending Plan is a complete departure from this process and the progress it has yielded. Senate leadership has developed an arbitrary treatment plan for an incorrect diagnosis that will ultimately damage the healthcare system that serves all North Carolinians. Read More

Adam O'Neal

Mayor Adam O’Neal – photo credit Twitter.com

“You can’t close hospitals and let people die to prove a point.” So spoke the conservative Republican mayor of Belhaven, North Carolina, Adam O’Neal, this morning at a press conference at the state Legislative Building in Raleigh.

O’Neal’s appearance (and his linking of hands with Rev. William Barber of the North Carolina NAACP) was the highlight of a powerful event at which advocates called on Gov. McCrory and legislative leaders to reverse course and admit that their ideologically-driven decision to refuse to expand the state’s Medicaid program under the terms of the Affordable Care Act is threatening the physical health of hundreds of thousands of North Carolinians and the financial health of dozens of hospitals — especially ones located in poorer, rural communities like Mayor O’Neal’s.

O’Neal’s speech was an especially moving and courageous act by a man who claimed to disagree with Rev. Barber on most issues and who obviously placed any political ambitions he might harbor at risk by so publicly breaking with the leaders of his own party. But it was also obviously heartfelt and genuine — a fact that made it all the more powerful. Read More

Medicaid expansionThe benefits to North Carolina and its citizenry of expanding Medicaid under the Affordable Care Act  have been explained many times, but they definitely bear repeating again today — Medicaid Expansion Lobby Day at the General Assembly (click here for details). Prof. Nancy MacLean of Duke University does the honors with the following helpful and handy list:

If North Carolina Accepts Medicaid Expansion:

  • 500,058 uninsured low-income North Carolinians would finally be protected by health insurance, many for the first time.
  • Each year, 2,840 individuals will live, who would otherwise die due to lack of health care coverage. Doctors will be able to catch their cancers and other illnesses early enough to treat them effectively, and provide treatment for other life –threatening illnesses such as high blood pressure and diabetes. Each one of the people whose lives will continue is a mother or father, daughter or son, sister or brother, friend and neighbor, so their survival will enhance many thousands of other lives and spare them the grief of loss. Read More

Medicaid expansionMedicaid — the absurd failure to expand it at federal expense for a half-million low-income North Carolinians and the state Senate’s latest remarkable proposal to slash the program still further– remains front and center in the state policy debate these days. Moral Monday protesters highlighted the issue last night and the real life stories of average working people whose lives are darker and shorter because of legislative leaders’ Scrooge-like behavior continue to pour in. Tomorrow, activists from an array groups will gather at the General Assembly to lift up this most obvious of issues once again.  Here’s yet another story that makes the case from the good folks over at Women AdvaNCe and Planned Parenthood:

Stuck in the Medicaid gap
By Emily Callen

A few weeks ago, while talking to people about Medicaid expansion at a festival in downtown Raleigh, I met Linda. Though she seemed tired after a day at work and was probably eager to change out of her Bojangles uniform, Linda took the time to talk to me. “I really need this,” she said, filling out a postcard urging legislators to take action. “I tried to sign up for Obamacare but it was just too expensive.”

I learned later that Linda, who considers herself generally healthy, had been in a car crash last December. Broken bones kept her out of work for a few weeks, and she still sees an orthopedist because her collarbone hasn’t healed yet. Since Linda doesn’t have insurance, she’s worked out a deal to pay her doctor a little bit each month. It will take her a long time to pay off the bill, and in the meantime she will continue to struggle to make ends meet.

Linda’s experience is not uncommon. She is one of over 300,000 North Carolinians who fall into the Medicaid Gap; Read More

Since assuming office Gov. McCrory has throttled the theme that Medicaid is broken and must be reformed. He began by offering a radical proposal of dismantling our current system and selling it off to private insurance plans. He has since backed away from that idea and now wants a more modest expansion of what currently works in Medicaid.

The House, in a bipartisan bill filed this session, clearly agrees with the Governor’s new approach. The legislation, spearheaded by Rep. Nelson Dollar, would build Accountable Care Organizations (or ACOs)  in Medicaid. These provider led ACOs would move us toward greater integration of care and away from fee-for-service medicine. Medicare is using the ACO model as are many private insurers. In fact, Medicaid is one of the only payers in the state not moving to this method of organizing care.

In its budget, the Senate flatly rejects this approach. That chamber wants Medicaid to move to full capitation. In other words, legislators want to provide a set budget to Medicaid. The insinuation is that the Senate prefers the Governor’s original plan to pay private insurers to care (or not care, as the case may be) for our most vulnerable citizens.

The Senate also engages in some fantasy by pulling Medicaid into a freestanding department that will engage the nation’s best health care minds in this ambitious reform effort. At least that’s how Sen. Louis Pate described the proposed process. The trouble, of course, is that the nation’s best health care minds consider North Carolina’s Medicaid program to be an important model and they aren’t interested in helping to dismember it. The nation’s best health care minds also aren’t interested in coming to our state and spending time tearing apart care for low-income people as the legislature reduces services, limits eligibility, and slashes the budget. We are, in short, engaged in the opposite of innovation.

Rep. Dollar is a smart chap and likely realizes that his ACO bill isn’t going anywhere as a piece of legislation. That means he will need to stick the proposal into the House budget to give it a fighting chance. Hence, the showdown mentioned in the title of this post.

Certainly the House is moving in a better direction. But it’s a good time to reflect that Virginia is having its own budget battle over Medicaid right now. Except instead of fighting over how to fiddle with (or blow up) a program that is working, Virginia’s leaders are having a serious discussion about using federal funds to expand Medicaid coverage to 400,000 people. If that happens it means that our tax dollars will help boost Virginia’s economy, bolster its rural hospitals, and support its citizens.

That will certainly be charitable of us, but not wise.