New N.C. Medicaid director talks health care reform

Asheville, N.C.

Julie Ball
Asheville Citizen-Times
May 2, 2014

State Department of Health and Human Services Secretary Aldona Wos named Cummings, 58, to the job Tuesday. He replaces former Medicaid director Carol Steckel, who resigned last year.

Cummings was in Asheville Friday meeting with officials at Mission Health. He also sat down to answer questions from staff at the Citizen-Times.

Question: What impact will Medicaid reform have on overall health care in Western North Carolina?

Answer: I think the reform package, the proposal we put forth has a lot of potential to put providers in charge of health care and give them a chance to - if they perform - have some financial benefits as well.

The proposal, the idea behind it is it will allow providers in areas to come together as a group and form what we call an accountable care organization. The idea behind an accountable care organization is the providers come together, they bring a number of Medicaid patients to North Carolina. North Carolina will then contractually work with them to say if you take care of say, for example, this 20,000 Medicaid patients, at the end of the year if we look and you've met our quality parameters and you've done a good job taking care of these patients and there are savings, the state is willing to share those savings with you.


Q: What about Community Care of North Carolina, the network that is in place now, what will its role be?

A: I was a medical director for CCNC for five years (at Community Care of the Sandhills) and so I believe in the model. I know it's a good model, and I think it's one we can build upon and incorporate into this ACO model.

If you think about what an accountable care organization will be doing, they will be doing exactly what CCNC does - the care coordination, going out working with the patient, making sure the patient knows medications they are supposed to be on, why they're on them, encouraging them to keep their appointments, getting them involved in their own care... . All of that really is what an accountable care organization is going to want to do, and in a way CCNC has laid the ground work for us.

There are 14 networks (as part of Community Care). It may be that some of the networks will want to form an ACO. It may be that some of the networks will join with their local Mission hospital or their local health system and form an ACO.

Q: What is the biggest goal with reform?

A: My vision for what we're trying to do here is create a health care system with Medicaid that is patient-centric, provider-driven and has predictability in the budget and then finally is sustainable for the future.