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North Carolina’s new take on Medicaid: Better value, better care?
State pushes change in claims management
Published Wednesday, December 6, 2017 9:26 pm
by Stephanie Carson, N.C. News Service

RALEIGH – While the federal government debates the future of health care, North Carolina is trying to steer its own path when it comes to coverage of the state's Medicaid population.

The state is awaiting federal approval for an amendment to how it structures payments and care.
Under the proposal, the state would contract with private entities that would manage a prepaid amount for enrollees, versus handling each claim itself.

Dave Richard, deputy secretary for medical assistance with the North Carolina Department of Health and Human Services, says the hope is that payments to medical providers will be processed more efficiently and the re-structuring will encourage more coordinated care for beneficiaries.

“We believe that the application that we’re submitting to the federal government actually will improve quality, because we're driving a lot of change in the way we think about health, and in particular health and health care in North Carolina,” he said.

Currently the state has a fee-for-service system, and instead would be moving to a managed care program.
Richard adds that the proposed system would also create greater cost predictability for the state, since it will budget for a specific amount with contractors that are then responsible for keeping the system in the black.

Richard says the new managed care system would also encourage providers to consider better continuity of care, looking at physical, mental and environmental factors.

“How can we pay you in a way that drives a greater value for the department so that people do get better and it's just not the process thing that we typically do in a fee-for-service system,” he said.

In addition, state officials want to increase access by expanding the Medicaid provider workforce in underserved areas.

The state is pursuing federal funds that would offer a loan repayment and incentive program over the next five years.


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