Medicaid Reform Holds Promise

Raleigh, N.C.

Opinion: Medicaid Reform Holds Promise

The Southern Pines Pilot
March 21, 2014

Although critics are already finding fault with the proposed drastic turnaround in how North Carolina handles Medicaid reimbursements, Dr. L. Allen Dobson Jr. makes a good argument that it's the way to go. FirstHealth likes it too.

Dobson is president of Community Care of North Carolina. He stopped by The Pilot the other day to help us get a better grasp on what the change from "managed care" to "accountable care" involves.

"We think it's a better approach," he said. "Under managed care, the state would bid the delivery of care to various insurance companies. Under accountable care, you move the delivery of care down to the provider level."

David J. Kilarski, CEO of FirstHealth of the Carolinas, called the Medicaid change "a step in the right direction," adding: "We have a solid history of working with the Community Care of the Sandhills on population health management, and we look forward to working with the state on developing a sustainable program to benefit the Medicaid population."

Predictability at Issue


Medicaid is the government health insurance program that benefits the poor, elderly and disabled. North Carolina spends about $13 billion per year on Medicaid, though the federal government picks up about two-thirds of the cost. At issue is how that money gets distributed.

The change is not an easy one for many laymen to grasp. Under managed care, it would have been the insurance companies doling out the money and telling doctors how much they were going to be reimbursed. Under the new system built around Accountable Care Organizations (ACOs), doctors and hospitals band together in hopes of providing more efficient and reasonably priced care.

A central issue throughout the debate has been the matter of trying to make Medicaid payments more predictable - which isn't easy in a field that has so many variables pressing in from all sides.

Cummings Has a Central Role

Secretary Wos calls the compromise realistic and achievable, though acknowledging that opponents will always find flaws...

There is one aspect of the plan that many Moore County residents should find encouraging: Deputy DHHS Secretary Robin Cummings, a cardiovascular surgeon well known and respected in his home town of Pinehurst, will lead the Division of Medical Assistance, or DMA. In this position, Cummings will be in charge of overseeing a team transforming Medicaid's operations.

Under the new approach, a federal program is mainly administered by the state. But now, another layer of local providers will play a central role.

Given the presence of FirstHealth and other high-quality medical facilities, surely Moore County enjoys greater expertise and professionalism in this field than most other places. That seems a healthy prognosis for success.