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NC Hospitals Offer Medicaid Solution

The current Medicaid system is creating a budget constraint on hospital systems, and a group of North Carolina systems have devised their own plan. (Hamza Butt/flickr)
The current Medicaid system is creating a budget constraint on hospital systems, and a group of North Carolina systems have devised their own plan. (Hamza Butt/flickr)
September 18, 2017

RALEIGH, N.C. -- It's the first of its kind in the Tar Heel State. A coalition of 11 North Carolina health systems has submitted a proposal to the state to offer a provider-owned health plan for Medicaid beneficiaries.

The plan, known as Provider-Led and Patient-Centered Care and Presbyterian Healthcare Services, is intended to meet the state's goal of finding a more predictable budget for Medicaid costs. Dr. Dev Sangvai, a physician co-chair of the plan, explained its significance.

"So I think what's unique here is you have 11 health care systems, spread throughout the state, who are working collaboratively,” Sangria said. "I like to think of it as a solution for North Carolina that was developed for North Carolina."

The plan has filed for an insurance license and will begin actively engaging health care providers across the state. The current system, where hospitals are reliant on pricing and payments from the state, has made it difficult for some to remain open.

Sangvai said that, in addition to being more cost efficient, their plan is more responsive to regional needs and preventive care because it involves regional health systems.

Lisa Farrell, the plan’s president and CEO, said the 11 health systems - which include Carolinas Health Care System, Duke University Health System, Mission Health and others - are continuing their discussions with community partners to ensure their plan meets the needs of its customers.

"Most of our focus now is on listening, it's on learning, understanding the needs in the community, building the best model that we can for Medicare beneficiaries,” Farrell said. "That will be our focus for a while. "

Sangvai said preventive care is a proven way to reduce long-term health care costs - an area often lacking for individuals with limited or inconsistent access to care.

"Identifying what are those best practices; a heavy focus on things like prevention, making sure individuals get their screening tests in a timely fashion and then helping those individuals who need additional services because of their illnesses,” he said, "a process we like to call care management."

There are at least 300 provider-owned plans nationwide, and they're growing in number. While the NC Provider-Owned Plans will only cover Medicaid in the beginning, others across the country are commercially available.

Stephanie Carson, Public News Service - NC