State Calls on Doctors, Hospitals to Share in Medicaid Reform

Raleigh, N.C.

Ted M. Natt, Jr.
The Southern Pines Pilot
March 14, 2014

A plan unveiled last month for changes in the state Medicaid program eschews managed care in favor of hospitals, doctors and clinics forming networks called accountable care organizations.

"We think it's a better approach," said Dr. L. Allen Dobson Jr., president of Community Care of North Carolina (CCNC). "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.

"It has to be local, because every community has different support systems."


DHHS Secretary Aldona Wos has called the compromise realistic and achievable, while admitting that some will criticize it as not strong enough, not quick enough and not forceful enough, and others will claim it’s too quick, too much and too intrusive.

"This proposal represents a fundamental improvement in how the state delivers Medicaid," Wos told the Medicaid Reform Advisory Group last month. "(It) puts patients first, helps create a sustainable Medicaid program, and builds on what we have in North Carolina."

Wos also announced last month that Deputy DHHS Secretary Robin Cummings, a cardiovascular surgeon who lives in Pinehurst, will lead the Division of Medical Assistance (DMA) and lead a team to transform Medicaid's operations. In his enhanced role, Cummings will oversee efforts to improve existing operating processes and identify opportunities to deliver Medicaid services more efficiently and effectively.

"He understands first-hand how Medicaid affects beneficiaries and providers and that will greatly benefit DMA during this transformation," Wos said.

Cummings said the historical challenges facing Medicaid have been compounded by unprecedented change in the health care industry.

"To preserve Medicaid for future generations, we must improve and strengthen the operations of the state's Medicaid program," he said. "I look forward to working with the expertise in the division to accomplish this worthy goal."

Dobson said CCNC plans to work with the McCrory administration and General Assembly to find a solution.

"You can't tackle any of these problems with quick fixes," Dobson said. "It’s got to be incremental."


Under the proposal, doctors and hospitals would continued to be paid as they are now, by billing for individual services. But the networks would be able to keep some of the savings if they keep costs below projections while showing that they are properly caring for patients. If an accountable care organization spends more than projected, it would be responsible for covering part of the cost.

"They're assuming some of the risk and some of the rewards," Dobson said. "We're trying to create a system that brings value. There's nothing like local accountability, which is what this is."

Dobson added that Moore County is "an ideal community" in which to implement the new proposal.

"I would expect this community to be one of the first to go up another rung or two," he said. "It takes time to build trust, but there are a lot of committed people here and around the state who want to get this right."